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Potential implications of US healthcare reform for American children
  1. Rachel Stein,
  2. Michael Silverstein
  1. Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Michael Silverstein, Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Vose Hall 3, 1 Boston Medical Center Place, Boston, MA 02118, USA; michael.silverstein{at}bmc.org

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Introduction

Approximately 47 million Americans – 16% of the total US population – lack health insurance.1 An additional 25 million have insurance plans that limit their access to services, or cover only a small percentage of expenses.2 The USA spends $7026 per capita on healthcare, which amounts to 16% of the nation's gross domestic product (GDP).1 2 By contrast, the UK, which covers all of its citizens, spends 8.3% of its GDP on healthcare, and Japan, 8.0%. Despite these high expenditures, US health outcomes, reflected in measures of infant mortality and life expectancy, lag behind those of most other developed nations.1 Many in the USA, therefore, consider healthcare reform long overdue, and such reform is one of President Obama's principal domestic initiatives. The Obama administration's vision for reform is based on three pillars: (1) expansion of coverage, (2) containment of costs and (3) improvement of quality. Although we discuss these tenets of healthcare reform specifically as they relate to children's health, we acknowledge that Obama's vision for healthcare reform is less focused on children's health than on other issues. Additionally, we recognise that his proposals have been victim to ideological pressures (specifically regarding reproductive rights and abortion), misinformation (many people believed Obama's reforms would establish death panels to force the elderly to proactively decline resuscitative efforts) and over-dramatisation of the government's control over the healthcare system.

Expansion of coverage

With regard to children, the goal of expanding coverage must be viewed in historical context. In 1997, under President Clinton, the Children's Health Insurance Program (CHIP) was established to provide coverage for children who did not qualify for Medicaid (the US government insurance programme for the poor) but whose families could not afford private insurance. This legislation reduced the rate of uninsured low-income children by almost one third, from 23% (7.6 …

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