As health reform discussions continue, one key topic that will need to be addressed is what will be included in the coverage provided and how well it will meet individuals’ health care needs. Because they are growing and developing, children have a distinct set of health care needs that evolve over time and differ from those of adults. Moreover, while as a group children are relatively healthy, one in seven has special health care needs. Given that under reform, many children will be covered through private plans and some children who are currently covered through public programs may be shifted to private plans, it is particularly important to consider how well private plans might meet children’s health care needs. A key question for children is what coverage standards will be applied to these private plans under reform.
In this paper, the authors begin by reviewing the research literature on children’s health needs. The authors then examine how two children with different health care profiles and utilization histories would fare with an insurance product – the Blue Cross Blue Shield Standard Option (BCBSSO) plan – that is likely to be considered a benchmark for coverage offered under a health insurance exchange.