Nearly five million uninsured children in the United States are currently eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but are not enrolled in these programs. A top Obama administration priority is to achieve the long-sought goal of ensuring that uninsured children are enrolled—and that they stay enrolled for as long as they are eligible. The author, who is secretary of the U.S. Department of Health and Human Services (HHS), outlines measures that HHS and other federal agencies are implementing to reach this goal. She also cites existing state efforts to enroll more children and improve children’s coverage, and she describes steps that states, local governments, and the private sector can take to expand outreach efforts, increase enrollment, and keep eligible children covered.

Kathleen Sebelius, secretary of health and human services, has issued a challenge to enroll the millions of uninsured children eligible for public insurance in Medicaid or the Children’s Health Insurance Program (CHIP). This paper provides estimates of the rates at which children in the various states participated in these programs in 2008 as well as the number who were eligible for them but uninsured. According to our coverage estimates, an estimated 7.3 million children were uninsured on an average day in 2008, of whom 4.7 million (65 percent) were eligible for Medicaid or CHIP but not enrolled. Participation rates varied across states from 55 percent to 95 percent, and ten states had participation rates close to or above 90 percent. Thirty-nine percent of eligible uninsured children (1.8 million) live in just three states—California, Texas, and Florida—and 61 percent (2.9 million) live in ten states. Meeting Secretary Sebelius’s challenge means achieving success in these populous states, in part through tools and resources available under the 2009 CHIP reauthorization law.

Our annual analysis of health benefits contains findings from interviews of 2,046 public and private employers surveyed during January–May 2010. Average annual premiums in 2010 were $5,049 for single coverage and $13,770 for family coverage—up 5 percent and 3 percent from 2009, respectively. Workers paid more toward premiums in 2010, and more workers are in consumer-directed plans and plans with high deductibles than in 2009. Thirty percent of firms reported that they reduced the scope of benefits or increased cost sharing because of the recession. Surprisingly, the percentage of firms offering health benefits in 2010 increased to 69 percent, up from 60 percent in 2009. The change was largely driven by a thirteen-percentage-point increase in the number of firms with three to nine workers that offered benefits (up from 46 percent in 2009 to 59 percent in 2010). The reason for this increase is unclear.

The Obama administration hopes that seven demonstrations will show that providing better and safer health care can forestall medical errors and malpractice lawsuits.