Skip to main content

Advertising Disclaimer »

Main menu

  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers
  • Other Publications
    • American Academy of Pediatrics

User menu

  • Log in
  • My Cart

Search

  • Advanced search
American Academy of Pediatrics

AAP Gateway

Advanced Search

AAP Logo

  • Log in
  • My Cart
  • Journals
    • Pediatrics
    • Hospital Pediatrics
    • Pediatrics in Review
    • NeoReviews
    • AAP Grand Rounds
    • AAP News
  • Authors/Reviewers
    • Submit Manuscript
    • Author Guidelines
    • Reviewer Guidelines
    • Open Access
    • Editorial Policies
  • Content
    • Current Issue
    • Online First
    • Archive
    • Blogs
    • Topic/Program Collections
    • AAP Meeting Abstracts
  • Pediatric Collections
    • COVID-19
    • Racism and Its Effects on Pediatric Health
    • More Collections...
  • AAP Policy
  • Supplements
    • Supplements
    • Publish Supplement
  • Multimedia
    • Video Abstracts
    • Pediatrics On Call Podcast
  • Subscribe
  • Alerts
  • Careers

Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Commentary

Congress Should Adopt a “Do No Harm to Children” Standard in Changes to Public Health Insurance

Benard P. Dreyer
Pediatrics March 2017, 139 (3) e20164324; DOI: https://doi.org/10.1542/peds.2016-4324
Benard P. Dreyer
Immediate Past President, American Academy of Pediatrics, and Professor of Pediatrics, New York University School of Medicine, New York, New York
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • Comments
Loading
Download PDF
  • Abbreviations:
    AAP —
    American Academy of Pediatrics
    ACA —
    Affordable Care Act
    ADHD —
    attention-deficit/hyperactivity disorder
    ASD —
    autism spectrum disorder
    CHIP —
    Children’s Health Insurance Program
  • In 2015, 21% of children, 15 000 000, were living in poverty (<100% of the federal poverty level).1 Forty-three percent of children, 31 000 000, were living below 200% of the federal poverty level, which is a better measure of economic hardship for families in the United States. Children are the poorest age group in our society and more than twice as poor as older adults. It is well documented that poor children are more likely to have poor health outcomes, including chronic conditions such as asthma. They are also at greater risk for poor social, emotional, and behavioral problems, including disobedience, impulsivity, and anxiety.2 Behavioral and mental health problems are common comorbidities of chronic conditions in children living in poverty.

    In this issue of Pediatrics, Pulcini et al3 present the results of their secondary analyses of the National Survey of Children’s Health for the years 2003, 2007, and 2011–12. Their purpose was to identify trends in parent-reported lifetime prevalence and comorbidity among children with asthma, attention-deficit/hyperactivity disorder (ADHD), and autism spectrum disorder (ASD). They found that poor and near poor children had a higher lifetime prevalence of asthma and ADHD, but not ASD, as well as higher rising prevalence rates of asthma from 2003 to 2011–12. ADHD rose in all income groups from 2003 to 2011–12, and ASD rose significantly from 2007 to 2011–12 only in the higher income groups. In multivariate regression analyses, poor children had higher than average comorbid conditions in 2011–12 for asthma and ADHD, but not ASD, and children on public health insurance had higher comorbid conditions for all 3 conditions.

    Although these results are not surprising, they substantiate the burden of chronic disease in poor children and the importance of access to health care for this vulnerable population. The contrasting findings for asthma and ADHD versus ASD are likely multifactorial but possibly due to community and family factors that influence asthma and ADHD and are more prevalent in poor children, whereas ASD prevalence is not increased by those factors. Even for ASD, however, children on public insurance were burdened with more comorbidities.

    These results raise important health policy considerations. More children are covered by health insurance today than ever before. In 2015, 95% of children were covered by health insurance, due primarily to the expansion of public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP).4

    However, the Affordable Care Act (ACA), although primarily insuring nonelderly adults and young adults (19- to 25-year-olds), did help to drive the increases in child health insurance coverage. Parents were offered sign up to public health insurance for their children when they sought insurance for themselves, and some children received health insurance through the ACA marketplace. An additional 1.7 million children received health insurance during the period that the major provisions of the ACA were implemented.4 The major advances in health insurance coverage occurred for poor and near poor children, although they still lag behind those at higher income, primarily due to higher uninsured rates among Latino children.

    The association of poverty and chronic disease among children is due to more than just health insurance status. As described in a recent American Academy of Pediatrics (AAP) policy on poverty and child health and an accompanied technical report, family, economic, and community factors are powerful social determinants of health outcomes in poor children.5,6 Nevertheless, all children, especially children with chronic diseases, require access to quality health care, for which health insurance is a prerequisite.

    Forty-two percent of children, and virtually all poor children, are ensured through public plans, primarily Medicaid and CHIP.7 This year, Congress is deliberating the fate of public health insurance that is essential for the health of children, such as potential cuts or block-granting of Medicaid to the states and an uncertain reauthorization of CHIP. As described here, dramatic changes to the ACA also have the potential to negatively affect children.

    We in the AAP, and pediatricians throughout the country, urge Congress to take a “do no harm to children” standard. Any changes in the ACA must not leave children worse off than they are today; there must be no structural changes to Medicaid; and CHIP must be reauthorized and strengthened. As described in the AAP Blueprint for Children,8 anything less will leave the most vulnerable children, who have an increased burden of chronic disease, without access to the essential, comprehensive health services they need to survive and thrive.

    Footnotes

      • Accepted December 27, 2016.
    • Address correspondence to Benard P. Dreyer, MD, 564 1st Ave, Apt 23 E, New York, NY 10016-6469. E-mail: benard.dreyer{at}nyumc.org
    • FINANCIAL DISCLOSURE: The author has indicated he has no financial relationships relevant to this article to disclose.

    • FUNDING: No external funding.

    • POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.

    • COMPANION PAPER: A companion to this article can be found online at www.pediatrics.org/cgi/doi/10.1542/peds.2016-2539.

    References

    1. ↵
      1. Kids Count Data Centers
      . Kids Count National Indicators. 2016. Available at: http://datacenter.kidscount.org/data#USA/1/16/17,18,19,20,22,21,2720/char/0. Accessed December 26, 2016
    2. ↵
      1. Moore KA,
      2. Redd Z,
      3. Burkhauser M,
      4. Mbwana K,
      5. Collins A
      . Children in Poverty: Trends, Consequences and Policy Options (Child Trends Research Brief. Publication #2009-11). Washington, DC: Child Trends; 2009. Available at: http://www.childtrends.org/wp-content/uploads/2013/11/2009-11ChildreninPoverty.pdf
    3. ↵
      1. Pulcini CD,
      2. Zima BT,
      3. Kelleher KJ,
      4. Houtrow AJ
      . Poverty and trends in three common chronic disorders. Pediatrics. 2017;139(3):e20164324
    4. ↵
      1. Alker J,
      2. Chester A
      . Children’s Health Insurance Coverage Rate at Historic High of 95 Percent. Washington, DC: Georgetown University Health Policy Institute, Center for Children and Families; 2016
    5. ↵
      1. AAP Council on Community Pediatrics
      . Poverty and child health in the United States—Policy Statement. Pediatrics. 2016;137(4):e20160339
    6. ↵
      1. Pascoe JM,
      2. Wood DL,
      3. Duffee JH,
      4. Kuo A; Committee on Psychosocial Aspects of Child and Family Health; Council on Community Pediatrics
      . Mediators and adverse effects of child poverty in the United States. Pediatrics. 2016;137(4):e20160340pmid:26962239
      OpenUrlAbstract/FREE Full Text
    7. ↵
      1. Centers for Disease Control and Prevention
      . National Center for Health Statistics, Health Insurance Coverage. Atlanta, GA: Centers for Disease Control and Prevention; 2016. Available at: www.cdc.gov/nchs/fastats/health-insurance.htm. Accessed January 30, 2017
    8. ↵
      1. American Academy of Pediatrics
      . Blueprint for Children: How the Next President Can Build a Foundation for a Healthy Future. 2016. Available at: www.aap.org/blueprint. Accessed October 26, 2016
    • Copyright © 2017 by the American Academy of Pediatrics
    PreviousNext
    Back to top

    Advertising Disclaimer »

    In this issue

    Pediatrics
    Vol. 139, Issue 3
    1 Mar 2017
    • Table of Contents
    • Index by author
    View this article with LENS
    PreviousNext
    Email Article

    Thank you for your interest in spreading the word on American Academy of Pediatrics.

    NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

    Enter multiple addresses on separate lines or separate them with commas.
    Congress Should Adopt a “Do No Harm to Children” Standard in Changes to Public Health Insurance
    (Your Name) has sent you a message from American Academy of Pediatrics
    (Your Name) thought you would like to see the American Academy of Pediatrics web site.
    CAPTCHA
    This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
    Request Permissions
    Article Alerts
    Log in
    You will be redirected to aap.org to login or to create your account.
    Or Sign In to Email Alerts with your Email Address
    Citation Tools
    Congress Should Adopt a “Do No Harm to Children” Standard in Changes to Public Health Insurance
    Benard P. Dreyer
    Pediatrics Mar 2017, 139 (3) e20164324; DOI: 10.1542/peds.2016-4324

    Citation Manager Formats

    • BibTeX
    • Bookends
    • EasyBib
    • EndNote (tagged)
    • EndNote 8 (xml)
    • Medlars
    • Mendeley
    • Papers
    • RefWorks Tagged
    • Ref Manager
    • RIS
    • Zotero
    Share
    Congress Should Adopt a “Do No Harm to Children” Standard in Changes to Public Health Insurance
    Benard P. Dreyer
    Pediatrics Mar 2017, 139 (3) e20164324; DOI: 10.1542/peds.2016-4324
    del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
    Print
    Download PDF
    Insight Alerts
    • Table of Contents

    Jump to section

    • Article
      • Footnotes
      • References
    • Info & Metrics
    • Comments

    Related Articles

    • No related articles found.
    • PubMed
    • Google Scholar

    Cited By...

    • No citing articles found.
    • Google Scholar

    More in this TOC Section

    • Ensuring the Safety of Maternal Immunization
    • Evaluating Intersectionality of Policies and Populations
    • Safety of Breastfeeding by Mothers With COVID-19: New Evidence From Israel
    Show more Commentary

    Similar Articles

    Subjects

    • Pulmonology
      • Pulmonology
      • Asthma
    • Advocacy
      • Child Health Financing
      • Advocacy
    • Journal Info
    • Editorial Board
    • Editorial Policies
    • Overview
    • Licensing Information
    • Authors/Reviewers
    • Author Guidelines
    • Submit My Manuscript
    • Open Access
    • Reviewer Guidelines
    • Librarians
    • Institutional Subscriptions
    • Usage Stats
    • Support
    • Contact Us
    • Subscribe
    • Resources
    • Media Kit
    • About
    • International Access
    • Terms of Use
    • Privacy Statement
    • FAQ
    • AAP.org
    • shopAAP
    • Follow American Academy of Pediatrics on Instagram
    • Visit American Academy of Pediatrics on Facebook
    • Follow American Academy of Pediatrics on Twitter
    • Follow American Academy of Pediatrics on Youtube
    • RSS
    American Academy of Pediatrics

    © 2021 American Academy of Pediatrics