title: Quality health care for children and the Affordable Care Act: a voltage drop checklist.
abstract: The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The "voltage drop" framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children's health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation.
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, and Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; tcheng2@jhmi.edu.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Cheng
authors.affiliation: Department of Pediatrics, and Center for Policy, Outcomes, and Prevention, Stanford University, Palo Alto, California; and.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine, Department of Health Policy and Management, Fielding School of Public Health, Department of Public Policy, Luskin School of Public Affairs, and Center for Healthier Children, Families, and Communities, University of California, Los Angeles, Los Angeles, California.
authors.forename: Neal
authors.initials: N
authors.lastname: Halfon
mesh_terms: D000293:Adolescent; D002648:Child; D002669:Child Welfare / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006801:Humans; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000592:standards*; D011320:Primary Health Care / Q000191:economics / Q000592:standards; D011787:Quality of Health Care / Q000191:economics* / Q000592:standards*; D014481:United States
keywords: Affordable Care Act; advocacy; child health financing; children; federal policy; health insurance; health reform