Quality health care for children and the Affordable Care Act: a voltage drop checklist
Open accessAbstract
The Affordable Care Act (ACA) introduces enormous policy changes to the health care system with several anticipated benefits and a growing number of unanticipated challenges for child and adolescent health. Because the ACA gives each state and their payers substantial autonomy and discretion on implementation, understanding potential effects will require state-by-state monitoring of policies and their impact on children. The “voltage drop” framework is a useful interpretive guide for assessing the impact of insurance market change on the quality of care received. Using this framework we suggest a state-level checklist to examine ACA statewide implementation, assess its impact on health care delivery, and frame policy correctives to improve child health system performance. Although children’s health care is a small part of US health care spending, child health provides the foundation for adult health and must be protected in ACA implementation.
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Receiving developmental support services is the last in a series of steps from screening to referral to evaluation to delivery, and each step is vulnerable to leakage ("voltage drops"), with disparities compounding throughout.
“Receiving these services is the last in a series of steps from screening to referral to evaluation to delivery. Each step is vulnerable to leakage (“voltage drops”), with disparities compounding throughout.10–12”
From Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination (2025) · cites this paper as [11]
The Abstract (page unavailable) describes a cascade of seven potential voltage drops ending in delivery of high-quality care, including a referral-access step. It does not describe the claimed sequence of developmental screening, referral, evaluation, and service delivery, or say that disparities compound across those steps. (LLM, conf=0.86)
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Cited by
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Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination
Nelson, B. B., Dudovitz, R. N., Romley, J. A., Thompson, L. R., Vangala, S., Gallegos, A., Gulsrud, A., Calderon, K., Porras-Javier, L., Herrera, P., et al. (2025) · Pediatrics · doi:10.1542/peds.2025-071644 · Cited by 4 · see citing works
- Authors
- Cheng, T. L., Wise, P. H., & Halfon, N.
- Affiliations
- Johns Hopkins University (US)
- Stanford University (US)
- University of California, Los Angeles (US)
- Corresponding author
- Halfon, Neal
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2014-10-01
- Volume
- 134
- Issue
- 4
- Pages
- 794-802
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC4179100
- OpenAlex
- W2045477988
- Cited by
- 17
- References
- 17
- Citations by year
- 2026: 1 · 2025: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 1 · 2017: 3 · 2016: 2 · 2015: 4
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- National Institutes of Health
- National Institute on Minority Health and Health Disparities (P20MD000198)
- Maternal and Child Health Bureau
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- Affordable Care Act, children's health care, quality of care, health insurance market reform, child health policy, health care delivery
- MeSH terms
- Adolescent, Child, Child Welfare, Health Services Accessibility, Humans, Primary Health Care, Quality of Health Care, United States, Patient Protection and Affordable Care Act
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