title: The future of health insurance for children with special health care needs.
abstract: BACKGROUND
  Because of their elevated need for services, health insurance is particularly important for children with special health care needs. In this article we assess how well the current system is meeting the insurance needs of children with special health care needs and how emerging trends in health insurance may affect their well-being.
  
  
  METHODS
  We begin with a review of the evidence on the impact of health insurance on the health care experiences of children with special health care needs based on the peer-reviewed literature. We then assess how well the current system meets the needs of these children by using data from 2 editions of the National Survey of Children With Special Health Care Needs. Finally, we present an analysis of recent developments and emerging trends in the health insurance marketplace that may affect this population.
  
  
  RESULTS
  Although a high proportion of children with special health care needs have insurance at any point in time, nearly 40% are either uninsured at least part of the year or have coverage that is inadequate. Recent expansions in public coverage, although offset in part by a contraction in employer-based coverage, have led to modest but significant reductions in the number of uninsured children with special health care needs. Emerging insurance products, including consumer-directed health plans, may expose children with special health care needs and their families to greater financial risks.
  
  
  CONCLUSIONS
  Health insurance coverage has the potential to secure access to needed care and improve the quality of life for these children while protecting their families from financially burdensome health care expenses. Continued vigilance and advocacy for children and youth with special health care needs are needed to ensure that these children have access to adequate coverage and that they fare well under health care reform.
authors.affiliation: Department of Pediatrics, School of Medicine, University of California, 3333 California St, Suite 265, San Francisco, CA 94118, USA. paul.newacheck@ucsf.edu
authors.forename: Paul W
authors.initials: PW
authors.lastname: Newacheck
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Houtrow
authors.forename: Diane L
authors.initials: DL
authors.lastname: Romm
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kuhlthau
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Bloom
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Van Cleave
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
mesh_terms: D002648:Child; D002669:Child Welfare; D019988:Children with Disabilities; D005102:Health Expenditures; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000639:trends*; D011787:Quality of Health Care; D014481:United States