By Gabi Kirsch, Research Data Analyst

Gabi is a research data analyst at ICF where she works on technical assistance and research projects relating to child poverty, Temporary Assistance for Needy Families and workforce programs.



For people struggling to make ends meet, access to healthcare is an important issue. As defined in Healthy People 2020—a government program aimed to improve the health of all Americans—access to healthcare includes access to health services, timeliness of care, and insurance coverage. Healthcare refers to what we might all think of as care under the supervision of a medical professional, but it also can include oral healthcare, mental health services, and accessibility of obtaining necessary prescription drugs – to name a few.

Healthy People 2020 also highlights barriers to health services, which include high cost and the lack of insurance coverage, service availability, and culturally competent care. One study found that health insurance does not protect people from medical debt. Authors note that medical debt as well as a lack of insurance coverage predicted decreased access to medical care. While this study focused on Arizona, the results have national implications. Other researchers have investigated the importance of culturally competent care. One study focused on oral health services for urban low-income children, emphasizing the importance of effective, culturally sensitive communication in improving the likelihood of regularly scheduled dental visits.

As explained on, two programs in the United States provide insurance coverage to low-income individuals: Medicaid and the Children’s Health Insurance Program (CHIP). CHIP provides low-cost health coverage to children (and pregnant women in some states) from families that earn too much to qualify for Medicaid. As of October 2018, more than 66.3 million Americans were enrolled in Medicaid and more than 6.5 million children were enrolled in CHIP. (For a comparison, approximately 39.7 million people total live in the state of California.) These programs help a large population of Americans in poverty overcome barriers of access to healthcare.

Both Medicaid and CHIP have expanded healthcare access to enrollees. Adults enrolled in Medicaid were five times more likely to have a consistent source of health care than uninsured adults and were four times more likely to receive preventative care services like routine checkups. The evaluation report of CHIP published in 2014 illustrates the program’s success in expanding health insurance coverage to children, reducing financial burdens and stress on low-income families. The evaluation also noted potential areas of program improvement. For example, a quarter of enrollees had an unmet need and fewer than half received key preventive services, such as immunizations and health screenings during checkups.

As practitioners, researchers, and policymakers continue their innovative work to support low-income populations, the Medicaid and CHIP programs provide support to improve access to healthcare. Check out the Self Sufficiency Research Clearinghouse to learn more about the intersection of healthcare access and self-sufficiency. Sign up for the bimonthly SSRC newsletter to keep up-to-date on current research on low-income families.


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