Publication Year



Journal of the American Medical Association


mplementation of the Affordable Care Act (ACA) is now underway. Insurance marketplaces known as exchanges are online and millions of Americans are enrolling in what were previously unobtainable insurance products. Although the ACA’s major thrust is to provide coverage for the uninsured, the ACA is also benefitting children by eliminating restrictions on preexisting conditions, limiting lifetime benefit caps, extending coverage of young adults on their parents’ policies to age 26 years, and insuring more parents.

Despite these clear benefits, the ACA could also potentially destabilize well-functioning elements of the current child health delivery system and undermine the ACA’s promise for improving child health. Child health is a foundation for adult health and should be a priority in ACA implementation. However, children’s health care is not the cost-driver of US health care spending, and designers of health reform, therefore, have not been particularly attentive to the special requirements of child health care provision. In addition, the ACA gives each state considerable autonomy over how they implement many provisions, creating opportunities for experimentation but also demanding vigilance in monitoring potential untoward effects on child health.


Cheng, T. L., Wise, P. H., & Halfon, N. (2014). Promise and perils of the Affordable Care Act for children. JAMA, 311(17), 1733-1734.


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