Online-only: Access to health care improving for U.S. children, but some states doing better than others, report finds
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* Teddi Dineley Johnson

Despite the U.S. economic downturn, more children are getting health insurance or holding on to their insurance. But some states are doing markedly better than others in promoting the health and development of their youngest residents, according to a new report evaluating how well the health care system is working for children.

The report, “Securing a Healthy Future: The Commonwealth Fund State Scorecard of Child Health System Performance, 2011,” pointed to the value of federal and state policies for increasing the numbers of children covered by health insurance. Even as coverage rates for parents declined in 41 states over the past decade, children have fared dramatically better, the report found, with coverage rates for children increasing in 35 states over the same period. Children living in Iowa, Massachusetts, Vermont, Maine and New Hampshire were more likely to be insured and to receive recommended medical and dental check-ups than children living in Florida, Texas, Arizona, Mississippi, Nevada and other poorer-performing states.

“While children were able to gain and keep their health insurance thanks to Medicaid and the Children’s Health Insurance Program, parents lost coverage as the job market deteriorated and the cost of health insurance rose to unaffordable levels,” said Commonwealth Fund Senior Vice President Cathy Schoen, the report’s co-author. “The study demonstrates how policies designed to maintain children’s health insurance and access to health care have helped children get the health care they need, especially in tough economic times.”

Yet, because so many parents are uninsured, children and their families will remain at high risk until 2014, when access to health insurance will be expanded to include nearly everyone in the United States, Schoen said.

The state-by-state scorecard attributes the growing numbers of insured children, in part, to Medicaid stabilization funds from the American Recovery and Reinvestment Act and the expansion and reauthorization of the State Children’s Health Insurance Program in 2009.

Drawing on the most recently available data, the report analyzes 20 indicators of how the health system is performing for children in each state. By comparing each state to benchmarks achieved in one or more states, the report found that if all states could do as well as the best states, 5.6 million additional children would have health insurance, about 10 million more children would receive routine preventive medical and dental checkups and nearly 600,000 additional children would be up-to-date on their vaccinations.

States in New England and the upper Midwest generally rank highest in the scorecard, and states across the South and Southwest rank lowest. But thanks to innovative state-wide efforts, exceptions shine through across all regions of the United States. For example, 94 percent of children in Alabama are insured, North Carolina has the highest rate of developmental screening and West Virginia does exceptionally well in ensuring access and high-quality care for its most vulnerable children. The report noted that when state and local policies target specific issue areas, they are often effective in improving care and outcomes.

States ranked highest for overall performance were Iowa, Massachusetts, Vermont, Maine, New Hampshire, Rhode Island, Hawaii, Minnesota, Connecticut, North Dakota, Pennsylvania, Wisconsin, Kansas and Washington. However, “all states have room to improve,” the report said, noting that no state ranked in the top half across all indicators and even leading states still have substantial shortfalls for children.

“If it’s possible to insure almost all of the kids in Alabama, it should be possible in Texas and Mississippi,” said Commonwealth Fund Vice President Edward Schor, MD. “State and health care system leaders just need to make it a priority.”

For more information or to download the report, visit [www.commonwealthfund.org](http://www.commonwealthfund.org).

*   Copyright The Nation’s Health, American Public Health Association