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Babies and the Affordable Care Act

Last week, two years after the law’s passage, the Supreme Court heard oral arguments on the constitutionality of four elements of the Affordable Care Act (ACA):

  • Monday, the first day of arguments, simply sought to decide whether the case could be heard at all before certain provisions of the ACA have been implemented. (The Anti-Injunction Act of 1867 states that a tax cannot be challenged in court until it has been charged. The charges in question under the ACA will not go into effect until 2014, leading some to question whether arguments on the constitutionality of the ACA could be heard until then.)
  • On Tuesday, the Justices heard arguments around the key question: is the individual mandate constitutional? In other words, they discussed whether Congress can require people to purchase insurance.
  • And on Wednesday, they considered two final questions: If the individual mandate is repealed, can the rest of the Act stand without it? Or would all benefits for children and families, such as those featured below, be lost as well? This question is referred to as “severability.” And, is the expansion of Medicaid to a broader population constitutional? This issue is frequently referred to as “expansion.”

Throughout the week, the Policy Baby Blog covered the story while exploring the law’s impacts on infants, toddlers, and families. Now Americans will have to wait three months for the Justices’ verdicts, expected by the end of June.

In the meantime, advocates for infants and toddlers can continue to educate the public about the ACA’s benefits for infants, toddlers, and families. Here is just a handful that we’ve been exploring at the Baby Blog over the past two weeks:

The ACA expands health care coverage to more children.

Today, Medicaid is the largest source of health care coverage for children in America, and starting in 2014, the ACA will expand Medicaid to include more families in need. (Due in large part to Medicaid, the national rate of uninsured low-income children of all ages fell from 28% in 1998 to 10.4% in 2010; and the ACA will lower that number further.) Medicaid is critical to ensuring that the youngest children have access to high quality, affordable, and consistent health care. And research demonstrates that Medicaid’s impact on the health outcomes of very young children is especially pronounced. Here are a few things you should know about babies, Medicaid, and the ACA:

  • Medicaid currently pays for 40% of births in America.
  • Medicaid is the largest source of health care coverage for children with special health care needs, and starting in 2014, the ACA will expand Medicaid to include more families in need.
  • Children make up more than half of all Medicaid beneficiaries but only 20% of Medicaid costs.
  • Because of the ACA, 17 million kids with pre-existing conditions can no longer be denied health coverage.

The ACA provides preventive care that is critical to healthy development.

In the past two years, an additional 14 million children have already benefitted from preventive services without their families having to pay a co-pay or premiums under their insurance plans. That means access to well-child visits, immunizations, regular screenings, and other services as laid out by the U.S. Preventive Services Task Force. These services are critical to young children’s healthy development, and all too often babies grow up without them. In 2010, 25% of two-year-olds in the U.S. have not received crucial immunizations, and in 2009 more than 10% of children age four and younger had not received a well-child visit in the past year. (That number jumps to almost 60% for uninsured children.) These unacceptable numbers are and will continue to be addressed by the preventive care provisions of the ACA.

  • Every dollar spent on vaccinations for children saves $16 down the line.
  • Childhood conditions like obesity, asthma, developmental delays, and mental health disorders can be successfully prevented or treated when identified early. Left untreated, however, they necessitate costly medical treatment in the future.

The ACA provides preventive care to women and mothers.

Section 1302 of the ACA includes maternity and newborn care in its list of Essential Health Benefits – services to be covered by Medicaid and other plans by 2014. In addition, Section 2713 requires that all non-grandfathered health plans cover preventive health care services – including preconception care, well woman visits, and perinatal care – with no cost-sharing. That means that, as the law is implemented, millions of women will gain access to these preventive health care services for themselves and their babies.

  • Mothers’ physical and mental health – as well as their lifestyle choices and environmental exposures – are central to babies’ pre- and postnatal development.

The ACA provides new federal funds for home visiting services.

The ACA’s home visiting services will give at-risk parents and children improved access to family preservation services that seek to decrease child maltreatment and families’ child welfare involvement.

  • By helping parents to understand and address their children’s physical, social-emotional, and cognitive development needs, home visiting cultivates families’ protective factors, nurtures parent-child attachment, and helps to ensure that parents have the resources necessary to caring for their children.
  • Home visiting is a particularly critical tool in serving infants and toddlers, who are difficult or impossible to reach through other programs. For more detailed information about the ACA’s impacts on infants and toddlers, read our posts, Happy Birthday to the Affordable Care Act (3/19/12), The ACA Toddles Toward Mothers, (3/23/12), Updates on the Supreme Court Oral Arguments on the Affordable Care Act (3/28/12), and Dispatch from the Supreme Court (3/28/12).


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