Study: More than one-third of U.S. kids lack adequate health insurance
Families of children with special health care needs and private insurance are hit the hardest.
A new analysis led by University of Pittsburgh School of Medicine researchers indicates that the rate of underinsured children rose from 30.6% to 34% between 2016 and 2019. That’s an additional 2.4 million kids. Families who have children with special health care needs and private insurance were hit particularly hard, researchers say.
The study, published Dec. 6 in Pediatrics, notes that underinsurance of children was mainly driven by increased rates of inadequate insurance rather than a rise in absent or inconsistent insurance.
“The main takeaway is that the insurance landscape is getting bleaker, and it’s hurting millions of families, specifically those who are the most vulnerable,” Justin Yu, lead author of the study and assistant professor of pediatrics in Pitt’s School of Medicine, said in a statement. “We need pediatric organizations and politicians to bring child health insurance to the forefront and make it a priority issue.”
What does this trend mean?
To understand pediatric insurance trends, Yu and his team analyzed data from the National Survey of Children’s Health, an annual survey about the physical and mental health of newborns through 17-year-olds. They defined “underinsured children” as those who lack continuous and adequate health insurance, with “adequate” meaning that insurance usually or always met a child’s needs, allowed children to see needed providers, and protected against what parents felt were unreasonable out-of-pocket expenses. According to Yu’s team of researchers, high fees may force families to delay or forgo care for their children.
Researchers suspect that the rise in unreasonable out-of-pocket expenses reflects broad trends in the insurance landscape. Insurers are increasingly transferring costs to individuals and families through higher copays and premiums and, increasingly, through high-deductible plans, they said. These trends may help explain the finding that children with private health insurance were more likely to be underinsured than those on public plans, such as Medicaid or Children’s Health Insurance Program (CHIP).
Another notable finding was an increase in the rate of underinsurance in kids considered to be more socioeconomically advantaged: white children from middle-income, highly educated families.
“We have this idea that if you have a full-time job with health insurance from your employer that your health care needs will be met,” senior author Amy Houtrow, a professor and vice chair of physical medicine and rehabilitation at Pitt’s School of Medicine and chief of pediatric rehabilitation medicine services at the University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, said in a statement. “But our data show that, increasingly, that’s not the case, especially for families who may be enrolled in lower-premium, high-deductible plans.”
Researchers concluded that tackling the problem of child underinsurance may require large-scale policy reforms such as broadening eligibility for Medicaid or creating a universal health insurance program for all U.S. kids. But smaller policy changes — such as making it easier to apply for and stay on Medicaid or cash assistance programs to help cover out-of-pocket expenses — also could help.
“Rather than providing a clear policy prescription, the goal of this study is to bring the issue of child underinsurance to the forefront of national conversation,” Yu said. “Once people are talking about this issue, we can start thinking about policies to address it.”