The implementation of the Patient Protection and Affordable Care Act (ACA) provided coverage to an additional 8.8 million people in the U.S. from 2013 to 2014. During that time period, Kentucky experienced the nation's largest decrease in uninsurance, dropping from 14.3% to 8.5% (see Figure 1). The increase in coverage has primarily affected adults because children were already more likely to be insured and because key ACA provisions were focused on adults. Yet, there is growing evidence suggesting the ACA also has had a significant impact health insurance for children, nationally and in Kentucky. The ACA and Kentucky's implementation of the law include components to provide enhanced access to coverage through new programs, and they also are expected to increase enrollment of children in existing programs. A new emphasis on enrollment through public outreach, advertising, and awareness campaigns also helped reach some children who were already eligible for Medicaid or the Children's Health Insurance Program (CHIP, named "K-CHIP" in Kentucky) prior to the ACA, but who were not enrolled. These children represent an estimated 3.7 million children nationwide, including 43,000 in Kentucky. In this brief, we describe the main mechanisms that impact Kentucky children under the ACA: (1) Financial assistance to help families purchase private insurance (2) increased enrollment in public coverage among children. Though there are other provisions in the ACA that also impact children--such as elimination of CHIP waiting periods and reforms preventing insurers from denying coverage or increasing premiums based on individuals' health status--in this brief, we focus on the two main mechanisms likely to have the largest effects on children's coverage. After a discussion of these reforms and their implications for children, we present some early findings about their impact on enrollment and coverage for Kentucky's children.
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