Researchers study impact of health care reform on child development

Education has long been associated with enhanced health and well-being in large part by allowing greater access to resources such as quality health care. With the aid of a new grant, an education professor at Penn State has started a project to study the flip side of that coin — how can health policies affect children’s learning and socioemotional development?

“Demographers always talk about how education is one of the best health policies in the world but I think this project explores if health policies can also be good education policies,” said Maithreyi Gopalan, assistant professor in the Department of Education Policy Studies in the College of Education.

Gopalan, who is also a Social Science Research Institute cofunded faculty member, recently received a grant of $41,650 from the Spencer Foundation (the only national foundation focused exclusively on supporting education research) to support her study, “The Effect of the ACA Medicaid Expansions on Children’s Development.” The co-principal investigators on the project are Lindsey Bullinger, assistant professor in the School of Public Policy at the Georgia Institute of Technology; and Caitlin Lombardi, assistant professor in the Department of Human Development and Family Sciences at the University of Connecticut.

The goal of Gopalan’s research is to examine the impact of the Patient Protection and Affordable Care Act (ACA), a comprehensive health care reform law also known as Obamacare, that was enacted in March 2010. One of the law’s primary goals was to expand the Medicaid program to cover all adults with income below 138% of the federal poverty level. To date, 37 states (including the District of Columbia) have adopted the Medicaid expansion; 14 states have not.

Specifically, Gopalan and her colleagues are trying to understand what impact insurance expansions for previously uncovered, low-income adults have had on children’s development and the mechanisms through which this may have occurred. minor-latin">Their goal is to reveal how public policy can potentially influence children’s development through their parents and uncover the mechanisms through which that occurs.

“Health insurance coverage for children has been shown to improve both short- and long-term educational outcomes,” the researchers wrote in their grant proposal. “Little is known, however, about how parental health insurance coverage influences children’s development.”

Gopalan and her colleagues plan to use data from a nationally representative sample of U.S. children for their year-long study. They will compare differences in the developmental trajectories of children in Medicaid expansion states relative to non-expansion states using a rigorous quasi-experimental research design.

The ACA has had a considerable impact on the number of adults who are eligible for Medicaid, the researchers stated in their proposal. They reported that in 2010, 2.65 million low-income parents (adults with dependent children) were uninsured, along with 12.4 million low-income adults without dependent children.

“Before the ACA, Medicaid eligibility among parents was limited to the very poor and women who have just given birth to a child,” they wrote in their proposal. “While the expansion was aimed at all low-income adults, parents with incomes between their state’s pre-ACA Medicaid eligibility threshold and 138% of the poverty line also became eligible for Medicaid. As a result, insurance rates among parents rose substantially following implementation.”

While previous research has shown an impact of the Medicaid expansions on adults’ physical and mental health as well as financial well-being, Gopalan said, “We wanted to find out if that kind of spills over to children as well.”

Gopalan said that she and her colleagues are focusing on two potential mechanisms through which expanded Medicaid access among adults could benefit children.

First, additional household income frees up economic resources for investments in children’s development. Additionally, family structural effects resulting from additional income — such as more time spent with children doing things like helping with homework, eating dinner as a family and helping children with early vocabulary — could also translate to enhancing children’s academic and socioemotional development.

Although the Spencer Grant has helped to jumpstart the project, Gopalan said, Penn State has been instrumental in the process. The study has received seed funding from the Population Research Institute and support from the Department of Education Policy Studies. She described the ACA study as “one project in a series that looks at health impacts on kids and what impact those health policies will have on educational outcomes.”

Gopalan, who earned a doctorate from the O'Neill School of Public and Environmental Affairs from Indiana University, Bloomington, has integrated her public policy background with her desire to reduce racial and socioeconomic disparities among children.

“I’ve always been interested in thinking about how policies outside of education can be important levers in reducing disparities within the schools and the schooling system,” she said. “I’m hoping that educational policy becomes a little more expansive in thinking about how influences that could lie outside of the schools affect students and schools in complex ways.”