Connecting Children and Families to Health Insurance: Why Are Cities Involved?

By Guest Blogger

This post was written by Chuan Teng, Senior Associate for Health Benefit Outreach at the National League of Cities (NLC). A version of this post originally appeared on NLC’s blog

In addition to new health coverage options available as part of the Affordable Care Act (ACA), millions of children and families are currently eligible for but not enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).

Although there are provisions in the ACA that will subsidize the purchase of private health insurance through the new marketplaces (exchanges), approximately 70 percent of the nation’s uninsured children currently qualify for coverage under existing Medicaid and CHIP programs. Connecting these children with Medicaid and CHIP is critical to curbing preventable disease and helping families avoid financial crises that result from unaffordable medical bills.

Cities, increasingly, have recognized that they have an important role to play in ensuring that eligible children get enrolled.

While cities differ in their level of involvement with health coverage and health care issues, many play a role in the organization, funding, and delivery of health care services through public hospitals, clinics, and other safety net programs. When families miss out on public health insurance programs, cities often end up funding the health care costs for uninsured families.

Cities have a vested interest in connecting families to health insurance and are proactively working to do so. Why?

  1. Communities are healthier when children and families have health insurance and access to a primary medical provider. Children with health insurance generally have better health outcomes throughout childhood because they are more likely to receive vaccinations for common diseases, seek preventative care, and access treatment when they become sick or injured.
  2. Children who have health insurance spend more time in school, which is associated with greater academic performance. Insured children also gain access to school sports programs, which commonly require proof of health insurance.
  3. Connecting children and families to coverage helps create a strong workforce and vibrant local economy. When children are sick, parents have to take time off work to care for their children. This leads to lost wages for families and lost earnings for local businesses.
  4. Having insurance keeps children healthier and relieves the need for parents to take time away from work, which fosters a strong workforce and healthy community.
  5. When people have access to preventative and primary care, illnesses can be controlled or avoided altogether, which frees up emergency departments to respond to legitimate emergency situations.
  6. Insured individuals use emergency services less frequently, which increases the capacity of emergency rooms to address true emergencies.

Why is keeping children and families uninsured not a good idea?

When children and families lack health insurance, not only are they generally less healthy, but they also are at a greater risk of developing unaddressed health conditions that lead to costly medical interventions.

Waiting to seek treatment until illnesses require emergency attention can plunge uninsured families into financial crisis since hospitals charge uninsured individuals two to four times more than what health insurers and public programs actually pay for hospital services. Additionally, medical debt is one of the leading causes, if not the leading cause, of bankruptcies in the nation.

Many times, people who lack insurance either do not seek treatment until their illness requires emergency attention, or they seek treatment in emergency rooms for non-emergency issues. Both of these practices lead to overcrowding in hospitals and decrease an emergency department’s capacity to handle true emergencies.

Why do you think it is important for cities to take part in connecting children and families to Medicaid and CHIP? Write to me at and let me know!

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