Coverage Challenges and Opportunities for Children under the Affordable Care Act

As many as 20 million children live in complex family arrangements that create challenges in accessing insurance coverage, according to estimates provided in a new issue brief prepared by researchers at the Urban Institute. This brief, commissioned by the Robert Wood Johnson Foundation, urges the Secretary of Health and Human Services to pay special attention during the regulatory process to ensure that these children don’t fall through the cracks and miss opportunities to gain coverage. The Affordable Care Act establishes a framework of both private and public health insurance options that relate to employment, income and citizenship. In some cases, parents and children in the same family may be eligible for different types of insurance.

The report states that complex family scenarios include:

§  variation within families regarding who is eligible for employer-sponsored insurance, public programs or health insurance exchange subsidies;

§  different immigration status among family members;

§  children living apart from at least one parent (such as with a single parent, grandparents or other relatives);

§  children in Native American schools;

§  children of prisoners; and

§  runaway, homeless and institutionalized children.

The brief, which can be found here, offers recommendations to be taken during health reform implementation to help address these complex family arrangements and ensure maximum coverage for children.


Cate Hodgetts
Staff Attorney
National Health Law Program

“Securing health rights for those in need”

1444 I Street NW, Suite 1105

Washington, DC 20005



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