Insuring America's Children

Prepared For

The David and Lucile Packard Foundation

Colorado Health Foundation


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Due to growth in the two major public coverage programs for children, Medicaid and the Children’s Health Insurance Program (CHIP), the percent of children without health insurance has declined consistently in the past decade. Despite a continuously tumultuous environment—from the severe economic downturn of 2008 through the intense debate over implementation of the Affordable Care Act (ACA)—states have been able to secure significant gains in coverage, facilitated by the CHIP Reauthorization Act of 2009, provisions of the ACA, and efforts of child and family advocates working within individual states and networked across states. Insuring America's Children, a multi-year grantmaking strategy of the David and Lucile Packard Foundation, strives to move all states toward the goal of attaining health coverage for all children by investing in targeted states that could show success and, in turn, influence other states to advance as well.

Insuring America’s Children began in 2007 with the Narrative Communications Project which provided competitive grant support and targeted technical assistance and training from Spitfire Strategies to strengthen the strategic communications efforts of state-based advocacy groups working to grow children’s health insurance coverage. The Finish Line Project, launched the following year, provides multi-year grant support; continued communications support from Spitfire Strategies; and training, support for policy analysis, and technical assistance from the Center for Children and Families at Georgetown University's Health Policy Institute. A third component of Insuring America’s Children provides funding for the National Academy for State Health Policy to support state officials working on children’s coverage through peer-to-peer learning and technical assistance.

Mathematica’s evaluation of Insuring America’s Children aimed to monitor the progress of the grantmaking strategy, identify effective advocacy activities, and inform decisionmakers in states and at the national level about promising coverage strategies and programs. In the first phase of the evaluation, the project team conducted in-depth site visits to six of the Finish Line states to gather insights and perspectives on the issue of children’s health coverage and the environment for expansion in each state. In the second phase, the project team conducted a retrospective study of the state-level grantees’ activities, including both the Narrative Communications Project and the Finish Line Project. More recently, the evaluation team has monitored grantees’ efforts to maintain focus on children’s health coverage during the ACA’s expansion of coverage to adults. Evaluation partners in the first phase included the Center for Studying Health System Change and the Urban Institute.


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