When the Bough Breaks: Children’s Healthcare Insurance and Pediatric Surgery

Children’s health insurance in the United States can be envisioned as a large, protective tree. At its outermost level, dense foliage represents insurance coverage, shielding children from the financial consequences of illness, injury, and congenital disease. This canopy is sustained by broad branches, or boughs, that extend coverage across populations and regions. Ultimately, the entire structure rests on two foundational trunks that provide core support for the system: private coverage (typically employer-based or purchased through the Affordable Care Act [ACA] Marketplace) and public coverage (primarily Medicaid and the Children’s Health Insurance Program [CHIP]) (Figure 1).