Supporting Advocacy to Achieve Universal Children's Health Coverage: Final Report on the KidsWell Campaign
- Children’s coverage rates reached an all-time high in 2014, the year in which the key coverage expansions authorized by the ACA took effect; 94 percent of children had some form of health insurance.
- States that expanded Medicaid coverage to low-income adults showed greater gains in children’s coverage compared to states that did not expand Medicaid coverage, but even non-expansion states made important strides in improving children’s coverage.
- Policy leaders in all seven KidsWell states agreed that the KidsWell groups play important roles in mitigating challenges to children’s health care coverage primarily by providing credible information to state officials and serving as a voice for underserved constituencies; policy leaders also believe grantees are effective at conducting various advocacy activities.
- Grantees attributed their successes in KidsWell to two prominent features of Atlantic’s grant-making approach: (1) providing multiyear funding and (2) trusting the grantees to deploy campaigns that would work in each state environment, rather than taking a prescriptive approach to advocacy campaigns.
When the Patient Protection and Affordable Care Act (ACA) passed in 2010, about 6.2 million children were uninsured; of those, nearly 70 percent were already eligible for coverage through Medicaid or the Children’s Health Insurance Program (CHIP) but not enrolled (Kenney et al. 2012). Recognizing the many benefits for children from having health insurance and identifying the ACA as an opportunity to close the children’s coverage gap, in 2011 the Atlantic Philanthropies (Atlantic) created the KidsWell campaign. KidsWell’s theory of change hypothesizes that if advocates at both state and national levels could leverage new funding and coverage opportunities created by the ACA, such as encouraging states to adopt the optional Medicaid expansion or to create user-friendly enrollment portals in their state marketplaces, eventually universal children’s health insurance coverage could be achieved. Atlantic invested nearly $29 million over six years to support advocates in seven states, as well as 10 national advocacy groups, to advance a coordinated agenda to accelerate progress in covering children in the short term, while building a lasting child advocacy infrastructure to maintain these gains in the long term. In 2013, Atlantic contracted with Mathematica Policy Research to evaluate the KidsWell campaign. Since that time, evaluators have produced case studies and an interim report, and published issue briefs based on those findings (Hoag et al. 2015; Hoag et al. 2014). This is the final evaluation report, and is based primarily on interviews with KidsWell grantees and policy leaders in the seven KidsWell states, as well as analysis of coverage trends for children before and during the KidsWell grant period.