Policy interventions to address child health disparities: moving beyond health insurance.

A full accounting of the excess burden of poor health in childhood must include any continuing loss of productivity over the life course. Including these costs results in a much higher estimate of the burden than focusing only on medical costs and other shorter-run costs to parents (such as lost work time). Policies designed to reduce this burden must go beyond increasing eligibility for health insurance, because disparities exist not only in access to health insurance but also in take-up of insurance, access to care, and the incidence of health conditions. We need to create a comprehensive safety net for young children that includes automatic eligibility for basic health coverage under Medicaid unless parents opt out by enrolling children in a private program; health and nutrition services for pregnant women and infants; quality preschool; and home visiting for infants and children at risk. Such a program is feasible and would be relatively inexpensive.