The Affordable Care Act, Medicaid and the Children’s Health Insurance Program have driven the uninsured rate among children to historic lows, but millions of U.S. kids still go without important health services, according to a new study.

The study by the Children’s Health Fund finds a quarter of American kids lack access to crucial health care. That translates to just over 20 million individuals under age 18.

Critical services include vaccinations, annual physicals, treatment of acute or chronic pain, mental health care and dental care.

Those missing out on such services include the country’s 3.3 million uninsured children as well as millions who are covered by a family health plan.

The top barrier to health care, above all else, is cost. It’s obviously a big issue for those who lack insurance, but it’s also a problem for those with health plans with high deductibles or co-pays.

Those who depend on Medicaid or ACA plans also have a hard time finding providers who will accept their insurance. As a result, many low-income Americans in rural areas have to travel long distances to get basic health care. In urban areas transportation can be a barrier as well if a doctor who accepts the patient’s insurance isn’t accessible by public transit.

Technology offers an opportunity to help patients who are struggling to find providers in their area. Practices that are putting in place telemedicine options, such as video consultations with patients, can help ease the financial and transportation burdens that prevent many low-income patients from taking time out of their day to go to the doctor’s office. They also make it much easier to squeeze a doctor’s consultation into a busy work schedule.

The impending repeal of the ACA has advocates for child health care nervous. While it was far from perfect from their perspective, Obamacare offered families of modest means an easy way to buy insurance.

“(N)one of the proposed replacements will do anything to mitigate what children would potentially lose if the A.C.A. is actually repealed,” Dr. Irwin Redlener, the study author, tells the New York Times.

While ACA plans’ sticker prices are often high, the great majority of enrollees receive subsidies that substantially reduce their premiums and out-of-pocket costs. What the repeal of the ACA will mean for millions of low and middle-income families that currently get coverage through Healthcare.gov largely depends on what Trump and Congressional Republicans decide to put in place in its stead. So far, that remains unclear.

Instant Insights /

Quarter of U.S. children lack critical health care access

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