This report from the Kaiser Family Foundation examines the health care needs and costs of children, profiling two particular children. 

From the report:

As health reform discussions continue, one key topic that will need to be addressed is what will be included in the coverage provided and how well it will meet individuals’ health care needs.  Because they are growing and developing, children have a distinct set of health care needs that evolve over time and differ from those of adults. Moreover, while as a group children are relatively healthy, one in seven has special health care needs.  Given that under reform, many children will be covered through private plans and some children who are currently covered through public programs may be shifted to private plans, it is particularly important to consider how well private plans might meet children’s health care needs. A key question for children is what coverage standards will be applied to these private plans under reform.

To examine how well a generous private plan today addresses the varying health needs of  children, this brief analyzes the specific health care needs of two children, including:

• Jacob, a 7-year-old boy who is in generally good health but suffers from the relatively common ailments of asthma and allergies; and
• Isabel, a 13-year-old girl who was born prematurely and has cerebral palsy and requires a broad range of acute and long-term services and supports that enable her to function and learn at school.

Profiles of the health care utilization of these children during the last year were developed through interviews with their parents. Their actual utilization was then compared to the benefit coverage and cost-sharing requirements of the Blue Cross Blue Shield Standard Option (BCBSSO) plan to determine which of their services would be covered and what their families would pay both in cost-sharing and for non-covered services. The BCBSSO is the most popular coverage option offered through the Federal Employees Health Benefits Program (FEHBP) and is similar in many respects to coverage offered by other large employers. Overall, it is generous in terms of the benefits covered, but it charges relatively significant cost-sharing. The analysis also considers what coverage these children would receive and the costs their families would pay under Medicaid’s EPSDT benefit package, which is specifically designed for children with low incomes and/or high health needs. 

Full report: Children and Health Care Reform (PDF | 1 MB)

Kaiser Family Foundation. (2009). Children and health care reform: assuring coverage that meets their health care needs. Alker, J., Pollitz, K., Wachino, V., Libster, J., and Paradise, J.