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Predictors of Children’s Health Insurance Coverage Discontinuity in 1998 Versus 2009: Parental Coverage Continuity Plays a Major Role

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Abstract

To identify predictors of coverage continuity for United States children and assess how they have changed in the first 12 years since implementation of the Children’s Health Insurance Program in 1997. Using data from the nationally-representative Medical Expenditure Panel Survey, we used logistic regression to identify predictors of discontinuity in 1998 and 2009 and compared differences between the 2 years. Having parents without continuous coverage was the greatest predictor of a child’s coverage gap in both 1998 and 2009. Compared to children with at least one parent continuously covered, children whose parents did not have continuous coverage had a significantly higher relative risk (RR) of a coverage gap [RR 17.96, 95 % confidence interval (CI) 14.48–22.29 in 1998; RR 12.88, 95 % CI 10.41–15.93 in 2009]. In adjusted models, parental continuous coverage was the only significant predictor of discontinuous coverage for children (with one exception in 2009). The magnitude of the pattern was higher for privately-insured children [adjusted relative risk (aRR) 29.17, 95 % CI 20.99–40.53 in 1998; aRR 25.54, 95 % CI 19.41–33.61 in 2009] than publicly-insured children (aRR 5.72, 95 % CI 4.06–8.06 in 1998; aRR 4.53, 95 % CI 3.40–6.04 in 2009). Parental coverage continuity has a major influence on children’s coverage continuity; this association remained even after public health insurance expansions for children. The Affordable Care Act will increase coverage for many adults; however, ‘churning’ on and off programs due to income fluctuations could result in coverage discontinuities for parents. If parental coverage instability persists, these discontinuities may continue to have a negative impact on children’s coverage stability as well.

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Acknowledgments

This study was financially supported by the Agency for Healthcare Research and Quality (AHRQ) (1 R01 HS018569), the Patient-Centered Outcomes Research Institute (PCORI), and the Oregon Health & Science University Department of Family Medicine. The authors are grateful for editing and publication assistance from Ms. LeNeva Spires, Publications Manager, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA.

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Authors and Affiliations

  1. Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode FM, Portland, OR, 97239, USA

    Jennifer E. DeVoe & Heather Angier

  2. Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mailcode FM, Portland, OR, 97239, USA

    Carrie J. Tillotson

  3. Family Medicine, The Ohio State University, 263 Northwood-High Building, 2231 North High Street, Columbus, OH, 43201, USA

    Lorraine S. Wallace

Authors
  1. Jennifer E. DeVoe
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  2. Carrie J. Tillotson
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  3. Heather Angier
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  4. Lorraine S. Wallace
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Correspondence to Heather Angier.

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DeVoe, J.E., Tillotson, C.J., Angier, H. et al. Predictors of Children’s Health Insurance Coverage Discontinuity in 1998 Versus 2009: Parental Coverage Continuity Plays a Major Role. Matern Child Health J 19, 889–896 (2015). https://doi.org/10.1007/s10995-014-1590-0

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