N.H. ranked in middle of pack when it comes to children's health care: report

With workers paying an average of over $6,100 per year toward employer-sponsored family coverage and Every Kid Healthy Week kicking off on April 24, the personal-finance website WalletHub this week released its report on 2023's Best and Worst States for Children's Health Care, as well as expert commentary.

In order to determine which states offer the most cost-effective and highest-quality health care for children, WalletHub compared the 50 states and the District of Columbia across 33 key metrics. The data set ranges from share of children aged 0 to 17 in excellent or very good health to pediatricians and family doctors per capita.

Best vs. Worst

• Massachusetts has the lowest share of uninsured children aged 0 to 18, 1.50 percent, which is 7.7 times lower than in Texas, the highest at 11.50 percent.
• The District of Columbia has the lowest share of children aged 0 to 17 with unaffordable medical bills, 3.00 percent, which is 4.9 times lower than in Wyoming, the highest at 14.60 percent.
• The District of Columbia has the most pediatricians per 100,000 residents, 44, which is 22 times more than in Mississippi, the fewest at 2.
• Montana has the lowest share of obese children aged 10 to 17, 10.20 percent, which is 2.5 times lower than in West Virginia, the highest at 26.00 percent.

For the full report and to see where your state or the District ranks, please visit:
https://wallethub.com/edu/best-states-for-child-health/34455

Expert Commentary

What are the most important steps parents can take to help their children grow up healthy?

"It is not always the first thing we think of, but high-quality education and stable housing are incredibly important for the health of an entire population. This is not to say that doctors are not important, but research shows that, across the population, most of our overall health outcomes are driven by factors beyond just hospitals and doctor visits. Some of the most important components include our environment, our behaviors, and social and environmental factors. There is a sort of health dividend that we enjoy when we receive an education or live in a safe house and neighborhood."
Mac McCullough, Ph.D., MPH - Associate Professor; Director of Public Health Agency Partnerships, Boise State University

"As a parent and someone working in public health, I think important steps include: routine preventive health care (e.g., annual well-checks and vaccinations) - including dental care, regular physical activity, good nutrition, limited screen time, regular school attendance, and daily engagement with a parent or guardian (e.g., playtime, sharing a meal)."
Derek S. Brown, Ph.D. - Associate Professor; Faculty Scholar, Washington University in St. Louis

With America's youth facing an ongoing mental health crisis, and nearly 60% of them with major depression not receiving treatment, what actions can parents and health care providers take to mitigate this crisis?

"Our COVID epidemic has brought to light a second epidemic: untreated childhood mental health and behavioral health problems. There should be no low-cost assessment and treatment on demand for children's mental health and behavioral health problems but there is nothing this uniform and guaranteed at present...Parents can use insurance to access mental health providers as well as seek special education services from public schools that can target mental and behavioral health problems interfering with school achievement. Enroll your child in any and all Medicaid extension programs for which they are eligible in your jurisdiction. Become an advocate for your child with the health care system (both Medicaid and the commercial insurance world), the school system, and the political system. Parents of children with mental health and behavioral health issues can and should organize around the issue of the need for guaranteed services."
Ann Marie Marciarille - Professor, University of Missouri Kansas City School of Law

"Parents and health care providers must normalize talking about mental health and seeking care for mental health. As parents, this means talking about feelings and emotions, healthy and unhealthy coping strategies, and treatment options in age-appropriate ways throughout childhood. This also includes role-modeling healthy coping strategies and seeking treatment for mental health needs as parents when needed. As health care providers, the American Academy of Pediatrics now recommends screening focused on behavioral, social, and emotional concerns for all children annually, and screening specifically for depression and suicide risk for all children twelve and older annually. This universal screening of children and adolescents is only a first step in addressing the burgeoning mental health needs, with health care providers then needing to work with youth and families to consider treatment options such as therapy and medications and to develop individualized plans for care and follow-up."
Kristin N. Ray, MD, MS, FAAP - Associate Professor; Director, Health Systems Improvement, UPMC Children's Community Pediatrics; Affiliated Faculty, Health Policy Institute; Director, General Academic Pediatrics Research Fellowship, University of Pittsburgh

Do you think the government should mandate that all children have health insurance coverage?

"Yes. Numerous research shows that early investment in health has long-term benefits. There are public health benefits of preventive care, like child vaccination. Fortunately, we have programs like CHIP with bipartisan support."
Prabal K. De, Ph.D. - Professor and Chair, Department of Economics and Business; Doctoral Faculty in Economics, City University of New York

"Insurance mandates have not proven particularly popular in the US, so it might be worth first considering if there are other ways to achieve the policy goal of getting children access to affordable health care. We have seen gains in the percentage of children with health insurance coverage over the past decade or so, and that is without a punitive mandate. Uninsurance rates are now around 5% for children. Unfortunately, we still see uneven gaps in coverage. Children from families below the poverty level are roughly 4-5 times more likely to lack insurance than children from the wealthiest families. Across states, we also see large discrepancies, with some states having uninsurance rates of 1-2% and others upwards of 10% or more. A mandate is a fairly blunt policy tool in that it does not always get at the nuance of the issue. It is plausible that a family simply might not have access to health insurance, for example if their state did not expand Medicaid under the ACA, or might not be able to afford it. So, before we apply a fairly blunt tool like a mandate it will be important to ensure that we provide avenues for families to have the opportunity to actually obtain affordable insurance."
Mac McCullough, Ph.D., MPH - Associate Professor; Director of Public Health Agency Partnerships, Boise State University