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Universal Health Coverage for Children: Current Barriers and New Paths Forward

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Note: This Evidence to Action brief was updated in January 2021 to include a note from the authors on the impact of the COVID-19 pandemic on children’s health insurance coverage. The remaining content of the brief has not changed from original publication.

Despite the well-documented benefits of and broad bipartisan support for children’s coverage, the U.S. has seen rising numbers of uninsured children since 2017, with nearly half a million children losing insurance coverage.

Increasing premiums and rising out-of-pocket costs in the private insurance market, as well as barriers to enrollment and threats to the future availability of public insurance are some of the trends signaling a crisis.

This Evidence to Action brief reviews the fragmented children’s health insurance market in the U.S, and the barriers families face in accessing adequate coverage. It then proposes a menu of policy options for state and federal policymakers to consider if they wish to achieve affordable, comprehensive coverage for all children.

For an overview of the children’s coverage environment and a summary of policy options offered in this resource, read our complementary policy brief.


Rubin D, Rosenquist R, McCarthy-Alfano M, Strane D, Glaser A