Children may not have health insurance even though parents do

Children may not have health insurance even though parents do

Having a parent with health insurance does not always guarantee coverage of children and teens. Jennifer E. DeVoe, M.D., D.Phil. (Oregon Health & Science University, Portland) and colleagues write in the October 22/29 issue of JAMA that even with at least one parent insured, about 4% of US children are not covered by any health insurance at some point during the year.

It is estimated that over 9 million children in the United States do not have health insurance. That figure doubles if one includes children who have a gap in coverage at some point during the year. "Stable health insurance coverage allows for consistent access to health care services, which contributes to better health outcomes. Discontinuities in children's health insurance coverage, even for only a few months, are associated with significant unmet health care needs," explain the researchers. A common public policy response to this problem is to extend public coverage to uninsured parents, thereby expanding insurance for children. However, there is little focus on families that have at least one insured parent but uninsured children.

The sample for the study conducted by Dr. DeVoe and colleagues came from pooled 2002-2005 data from the nationally representative Medical Expenditure Panel Survey (MEPS). The researchers studied the demographic and socioeconomic characteristics of children and adolescents less than 19 years old who had a high likelihood of being in families where only parents were covered by health insurance.

In the cross-sectional study population, 3.3% of children and adolescents (1,380 of 39,588) did not have insurance even though they had at least one insured parent. In addition, 27.9% of uninsured children had an insured parent. The researchers found that characteristics such as low- and middle-income households, low parental educational attainment (less than a high school degree), Hispanic ethnicity, single-parent households, living in the South or West of the country, and having a parent with private insurance coverage were all associated with a higher likelihood of a child or adolescent's not having health insurance despite having a parent with insurance.

The authors clarify that, "When weighted, these estimates represent 3 million children who had a coverage gap despite having at least 1 parent who had full-year coverage. More than a million of these children were without coverage for the entire year."

"If families are better off covered under 1 plan but U.S. society rejects a public health insurance program for all members of the family, the question of whether the employer-based model is sustainable may need to be revisited. In this study, the private system did not do a good job of providing coverage for entire families," write DeVoe and colleagues.

The researchers conclude that: "Incremental expansions in public insurance programs for children will continue to improve insurance rates in the short term. However, the longer-term solutions to keeping all children insured are likely to be more complicated. Unless health insurance coverage models are designed to keep entire families covered, some children will continue to get left behind. It is time to think beyond health insurance models to achieve a sustainable health care system and the best possible health outcomes for all families."

Uninsured Children and Adolescents With Insured Parents

Jennifer E. DeVoe; Carrie Tillotson; Lorraine S. Wallace

JAMA ; 300[16]: pp. 1904-1913.

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