The ability of insurance to adequately cover needed services, providers, and costs is an important measure of health insurance coverage. While most children have health insurance, many may be underinsured. Among children with continuous coverage, those with private insurance are more likely to report that their coverage is inadequate compared to those with public insurance. Underinsured children are significantly more likely to have delayed or forgone care and to have difficulty obtaining needed specialist care. Older children, Hispanic and non-Hispanic black children, those with special health care needs, and those who are not in very good or excellent health are also more likely to be underinsured.

There is vast evidence documenting the benefits of health insurance coverage — whether it be public or private — for improving children’s access to care, improving quality of care, improving health outcomes, increasing use of preventive services, and reducing racial and ethnic disparities. Children without insurance tend to have greater severity of illness; higher rates of chronic illness (eg, asthma, diabetes), vaccine-preventable disease, and hospital admissions; higher mortality rates; and greater medical costs, compared to children with coverage. Despite great effort in recent years to reduce the number of children without health insurance, some children remain uninsured.

While homelessness is difficult to accurately estimate, approximately 600,000 families with 1.35 million children experience homelessness each year. Homeless families are more likely to be female-headed, be members of a racial minority group, and have low educational attainment. Twentynine percent of homeless families have a member that is employed, yet the family is still displaced. Homeless children are more likely to witness violent events and experience more acute and chronic health problems. The primary cause of family homelessness is lack of affordable housing. Intimate partner violence is a common cause of homelessness for single women and their children.

Community water fluoridation is an effective way of preventing dental caries — an infectious disease in which bacteria dissolve the enamel of a tooth. Dental caries can lead to pain, bacterial infections, and tooth extraction. Fluoride enhances remineralization and inhibits demineralization in tooth enamel and inhibits bacterial activity in dental plaque. Community water fluoridation is a safe and cost effective intervention to widely deliver fluoride to all members of a community, regardless of age, education, and income. It was named one of ten great public health achievements of the 20th century by the Centers for Disease Control and Prevention.