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According to the UN, children are one of the most vulnerable populations (Burns, Dunn, Brady, Starr, & Blosser, 2013). Despite the efforts of the U.S. government to ensure a thorough health care coverage for all children who are residents of the country, there remains a number of children who are uninsured and have no access to medical care, usually due to the parents’ low income and difficult living conditions (HRSA, 2015). This paper aims to examine the gaps in pediatric care coverage, as well as the reasons for these shortcomings.
HRSA’s (2015) analysis of health care use by pediatric population shows that the primary source of pediatric care is the doctor’s office: “Among children with a usual source of care in 2012, 74.2 percent of children used a doctor’s office; 23.9 percent used a clinic; and 1.9 percent used the hospital and other places, including emergency rooms and hospital outpatient departments” (p. 91). However, the preferred source of care varies considerably by family income, as well as race and ethnicity. For instance, HRSA (2015) states that children with household incomes of less than 200 percent of poverty were about twice as likely to use a clinic as a usual source of care than children with higher household incomes. Insurance coverage provided to children is either public or private, with private insurance usually being provided by the parent’s employer and public insurance supported by Medicaid or state-governed plans (HRSA, 2015). Children’s insurance coverage varies between populations: where the prevalent type of insurance for non-Hispanic white children is private (68.6), non-Hispanic black children are twice more likely to use public insurance (58.8) (HRSA, 2015). The percentage of uninsured children is high in Hispanic and native populations – 11.8 and 11.9 respectively (HRSA, 2015). The overall percentage of uninsured children has been gradually decreasing over the past decade but remains relatively high at 6.6 (HRSA, 2015).
Therefore, the lack of universal insurance coverage is evident, meaning that the current health care sources of the U.S. are not sufficient to cover the entire pediatric population. The majority of child populations that are affected by these impairments are racial and ethnic minorities, such as Hispanic, Native American, and Black (HRSA, 2015). However, the family income also plays a vital role in health care access (HRSA, 2015). One of the main reasons for the difficulties in health care access is the refusal of some states to adopt the Affordable Care Act of 2010 and the Medicaid expansion. According to Blumental, Abrams, and Nuzum (2015), the Medicaid expansion has been effective in lowering the rate of uninsured persons and increasing access to health care, particularly in the low-income, Hispanic, and Black populations: “Groups that have historically been at the greatest risk for lacking insurance — young adults, Hispanics, blacks, and those with low incomes — have made the greatest coverage gains” (p. 2451). The overall number of uninsured persons declined from 16.4 million to 7.0 million over the 5-year period (Blumental et al., 2015). Nevertheless, there are 19 states that have not adopted the expansion act yet, which means that the health care access of vulnerable children in these states remains limited.
Overall, it is clear that the vast part of the pediatric population with limited access to healthcare is from low-income, Hispanic, and Black households (HRSA, 2015). The primary barrier that prevents their access to health care is limited public insurance. The ACA has managed to expand health insurance in some states; however, while there are still states that refuse to accept the expansion, the children living in these states will be subject to impaired health insurance and care.
Blumental, D., Abrams, M., & Nuzum, R. (2015). The Affordable Care Act at 5 years. The New England Journal of Medicine, 372(25), 2451-2458.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Saunders.
U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA). (2015). Child health USA 2014. Rockville, MD: U.S. Department of Health and Human Services. Web.