Covering all kids: states setting the pace

Abstract

Providing health insurance coverage for the uninsured is a challenge that has remained unresolved for decades. In the absence of a national solution, states have initiated their own efforts to expand access to health insurance coverage, particularly for children. Half of the states have enacted or are in the process of debating expansions of their Medicaid and State Children's Health Insurance Programs, in many cases without the guarantee of federal financial support. Indeed, nine states have decided to pursue what can be considered "universal" children's coverage--providing access to some form of affordable health insurance coverage for all children in the state, regardless of family income. This issue brief provides a history and status of state children's coverage initiatives and features several states that appear to be setting the pace by developing successful strategies for expansion and cultivating the political will and leadership needed to institute them. In highlighting some of the key lessons that can be learned from states' experiences, this paper may inform the broader discussion about health reform and offer some insights into the federal-state dynamics that are at play.