Quality health care for children and the affordable care act: A voltage drop checklist

Tina L. Cheng, Paul H. Wise, Neal Halfon

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)794-802
Number of pages9
Issue number4
StatePublished - 2014


  • Advocacy
  • Affordable care act
  • Child health financing
  • Children
  • Federal policy
  • Health insurance
  • Health reform

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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