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Insurance Coverage Gaps Among US Children with Insured Parents: Are Middle Income Children More Likely to Have Longer Gaps?

Maternal and Child Health Journal volume 15, pages 342–351 (2011)Cite this article

Abstract

Millions of US children have unstable health insurance coverage. Some of these uninsured children have parents with stable coverage. We examined whether household income was associated with longer coverage gaps among US children with at least one insured parent. A secondary data analysis of the nationally-representative 2004 Medical Expenditure Panel Survey, this study uses logistic regression models to examine the association between income and children’s insurance gaps. We focused on children with at least one parent insured all year (n = 6,151; estimated weighted N = 53.5 million). In multivariate models, children from families earning between 125 and 400% of the federal poverty level (FPL) had twice the odds of experiencing coverage gaps >6 months, as compared to those from high income families. Children in the poorest income groups (<125% FPL) did not have significantly greater odds of a gap >6 months. However, the odds of a gap ≤6 months were significantly greater for all income groups below 400% FPL, when compared to the highest income group. Among children with continuously insured parents, those from lower middle income families were most vulnerable to experiencing coverage gaps >6 months, as compared to those from the lowest and highest income families. These findings are likely due to middle class earnings being too high to qualify for public insurance but not high enough to afford private coverage. This study highlights the need for new US health care financing models that give everyone in the family the best chance to obtain stable coverage. It also provides valuable information to other countries with employer-sponsored insurance models or those considering privatization of insurance payment systems and how this might disproportionately impact the middle class.

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References

  1. Iglehart, J. (2007). The battle over SCHIP. New England Journal of Medicine, 357, 957–960.

    PubMed  Article  Google Scholar 

  2. Curfman, G., Morrissey, S., & Drazen, J. (2007). No child left uncovered. New England Journal of Medicine, 357, 1036–1037.

    PubMed  Article  CAS  Google Scholar 

  3. Children’s Health Insurance Program Reauthorization Act of 2007. Kaiser Family Foundation, 2007 . Accessed January 10, 2008, at http://www.kff.org/medicaid/upload/7714.pdf.

  4. Perrin, J. M. (2007). SCHIP, children, and politics. Ambulatory Pediatrics, 7, 405–406.

    PubMed  Article  Google Scholar 

  5. Health Coverage for Low-Income Children. (2004). Accessed August 20, 2007, at http://www.kff.org/uninsured/upload/2144-05.pdf.

  6. Olson, L. M., Tang, S. F., & Newacheck, P. W. (2005). Children in the United States with discontinuous health insurance coverage. New England Journal of Medicine, 353, 382–391.

    PubMed  Article  CAS  Google Scholar 

  7. Fairbrother, G. L., Emerson, H. P., & Partridge, L. (2007). How stable is Medicaid coverage for children? Health Affairs, 26, 520–528.

    PubMed  Article  Google Scholar 

  8. Tang, S. F., Olson, L. M., & Yudkowsky, B. K. (2003). Uninsured children: How we count matters. Pediatrics, 112, e168–e173.

    PubMed  Article  Google Scholar 

  9. Children’s Health—Why Insurance Matters. Kaiser Family Foundation, 2002. Accessed August 20, 2007, at http://www.kff.org/uninsured/4055-index.cfm.

  10. Newacheck, P. W., Stoddard, J. J., Hughes, D. C., & Pearl, M. (1998). Health insurance and access to primary care for children. New England Journal of Medicine, 338, 513–519.

    PubMed  Article  CAS  Google Scholar 

  11. Gadomski, A., Jenkins, P., & Nichols, M. (1998). Impact of a Medicaid primary care provider and preventive care on pediatric hospitalizations. Pediatrics, 101, e1.

    PubMed  Article  CAS  Google Scholar 

  12. Guendelman, S., & Pearl, M. (2004). Children’s ability to access and use health care. Health Affairs, 23, 235–244.

    PubMed  Article  Google Scholar 

  13. Hadley, J. (2003). Sicker and poorer: The consequences of being uninsured. Medical Care Research and Review, 60, 3S–75S.

    PubMed  Article  Google Scholar 

  14. Newacheck, P., Hughes, D., & Stoddard, J. (1996). Children’s access to primary care: Differences by race, income, and insurance status. Pediatrics, 97, 26–32.

    PubMed  CAS  Google Scholar 

  15. Stevens, G. D., Seid, M., & Halfon, N. (2006). Enrolling vulnerable, uninsured but eligible children in public health insurance: Association with health status and primary care access. Pediatrics, 117, e751–e759.

    PubMed  Article  Google Scholar 

  16. DeVoe, J. E., Graham, A., Krois, L., Smith, J., & Fairbrother, G. L. (2008). “Mind the gap” in children’s health insurance coverage: Does the length of a child’s coverage gap matter? Ambulatory Pediatrics, 8, 129–134.

    PubMed  Article  Google Scholar 

  17. Hudson, J. L., & Selden, T. M. (2007). Children’s eligibility and coverage: Recent trends and a look ahead. Health Affairs, 26, w618–w629.

    PubMed  Article  Google Scholar 

  18. Sommers, A., Dubay, L., Blumberg, L., Blavin, F., & Czajka, J. (2007). Dynamics in Medicaid and SCHIP eligibility among children in SCHIP’s early years: Implications for reauthorization. Health Affairs, 26, w598–w607.

    PubMed  Article  Google Scholar 

  19. Sommers, B. (2007). Why millions of children eligible for Medicaid and SCHIP are uninsured: Poor retention versus poor take-up. Health Affairs, 26, w560–w567.

    PubMed  Article  Google Scholar 

  20. DeVoe, J., Krois, L., Edlund, C., Smith, J., & Carlson, N. (2008). Uninsurance among children whose parents are losing Medicaid coverage: Results from a statewide survey of Oregon families. Health Services Research, 43, 401–418.

    PubMed  Article  Google Scholar 

  21. Wilson, J., Wallace, L., & DeVoe, J. (2009). Are state Medicaid application enrollment forms readable? Journal of Health Care for the Poor and Underserved, 20, 423–431.

    PubMed  Article  Google Scholar 

  22. Dubay, L., Holahan, J., & Cook, A. (2007). The uninsured and the affordability of health insurance coverage. Health Affairs, 26, w22–w26.

    PubMed  Article  Google Scholar 

  23. Dubay, L. C., & Kenney, G. (2003). Expanding public health insurance to parents: Effects on children’s coverage under Medicaid. Health Services Research, 38, 1283–1301.

    PubMed  Article  Google Scholar 

  24. Sommers, B. D. (2005). From Medicaid to uninsured: Drop-out among children in public insurance programs. Health Services Research, 40, 59–78.

    PubMed  Article  Google Scholar 

  25. DeVoe, J. E., Tillotson, C., & Wallace, L. (2008). Uninsured children with insured parents. JAMA, 300, 1904–1913.

    PubMed  Article  CAS  Google Scholar 

  26. Weinick, R. M., Zuvekas, S. H., & Drilea, S. K. (1997). Access to health care: Source and barriers, 1996; MEPS Research Findings No. 3. AHCPR Pub. No. 98–0001. Rockville, MD: Agency for Health Care Policy and Research.

    Google Scholar 

  27. Zuvekas, S. M., & Weinick, R. M. (1999). Changes in access to care, 1977–1996: The role of health insurance. Health Services Research, 34, 271–279.

    PubMed  CAS  Google Scholar 

  28. Cohen, J., Monheit, A., Beauregard, K., et al. (1996). The Medical Expenditure Panel Survey: A national health information resource. Inquiry 373–389.

  29. Cohen, S. (1997). Sample design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2, Pub. No. 97–0027. Rockville, MD: Agency for Healthcare Research and Quality.

    Google Scholar 

  30. MEPS HC-089: 2004 Full Year Consolidated Data File. (2004). Accessed January 10, 2008, at http://www.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h89/h89doc.pdf.

  31. Larson, K., & Halfon, N. (2009). Family income gradients in the health and health care access of US children. Maternal and Child Health Journal (Epub ahead of print).

  32. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9.

  33. Perry, M., & Paradise, J. (2007). Enrolling children in Medicaid and SCHIP: Insights from focus groups with low-income parents. Washington DC: Kaiser Commission on Medicaid and the Uninsured.

    Google Scholar 

  34. Resuming the Path to Health Coverage for Children and Parents: A 50 State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and SCHIP in 2006. The Kaiser Family Foundation, 2007. Accessed April 30, 2007, at Available at http://www.kff.org/medicaid/upload/7608.pdf.

  35. DeVoe, J., Baez, A., Angier, H., Krois, L., Edlund, C., & Carney, P. (2007). Insurance + access does not equal health care: Typology of barriers to health care access for low-income families. Annals of Family Medicine, 5, 511–518.

    PubMed  Article  Google Scholar 

  36. Weinick, R. M., & Krauss, N. A. (2000). Racial/ethnic differences in children’s access to care. American Journal of Public Health, 90, 1771–1774.

    PubMed  Article  CAS  Google Scholar 

  37. SCHIP Ever Enrolled in Year. 2007. Accessed December 3, 2007, at http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/SCHIPEverEnrolledYearGraph.pdf.

  38. Building an Express Lane Eligibility Initiative: A Roadmap of Key Decisions for States. Kaiser Family Foundation, 2010. Accessed January 26, 2010, at http://www.kff.org/medicaid/upload/8043.pdf.

  39. Fairbrother, G., Dutton, M. J., Bachrach, D., Newell, K.-A., Boozang, P., & Cooper, R. (2004). Costs of enrolling children in Medicaid and SCHIP. Health Affairs, 23, 237–243.

    PubMed  Article  Google Scholar 

  40. Kronebusch, K., & Elbel, B. (2004). Simplifying children’s Medicaid and SCHIP. Health Affairs, 23, 233–246.

    PubMed  Article  Google Scholar 

  41. Remarks by President Barack Obama on Children’s Health Insurance Program Bill Signing. 2009. Accessed December 29, 2009, at http://www.whitehouse.gov/the_press_office/RemarksbyPresidentBarackObamaOnChildrensHealthInsuranceProgramBillSigning/.

  42. Rosenbaum, S. (2009). Medicaid and national health care reform. New England Journal of Medicine, 361, 2009–2012.

    PubMed  Article  CAS  Google Scholar 

  43. Davidoff, A. J., Garrett, A. B., Makuc, D. M., & Schirmer, M. (2000). Medicaid-eligible children who don’t enroll: Health status, access to care, and implications for Medicaid enrollment 203–218.

  44. Ross, D. C., & Cox, L. (2002). Enrolling children and families in health coverage: The promise of doing more. Washington DC: Kaiser Family Foundation.

    Google Scholar 

  45. Ross, D. C., & Hill, I. T. (2003). Enrolling eligible children and keeping them enrolled. The Future of Children, 13, 81–97.

    PubMed  Article  Google Scholar 

  46. DeVoe, J. E., Krois, L., Edlund, C., Smith, J., & Carlson, N. (2007). Uninsured but eligible children: Are their parents insured? Recent findings from Oregon. Medical Care, 46, 3–8.

    Article  Google Scholar 

  47. Dubay, L. C., & Kenney, G. (2001). Covering parents through Medicaid and SCHIP: Potential benefits to low-income parents and children. Washington DC: The Kaiser Commission on Medicaid and the Uninsured.

    Google Scholar 

  48. Dubay, L. C., & Kenney, G. (2004). Addressing coverage gaps for low-income parents. Health Affairs, 23, 235–244.

    Article  Google Scholar 

  49. Sommers, B. (2006). Insuring children or insuring families: Do parental and sibling coverage lead to improved retention of children in Medicaid? Journal of Health Economics, 25, 1154–1169.

    PubMed  Article  Google Scholar 

  50. Vistnes, J., & Schone, B. (2008). Pathways to coverage: The changing roles of public and private sources. Health Affairs, 27, 44–57.

    PubMed  Article  Google Scholar 

  51. Institute of Medicine. (2002). Health insurance is a family matter. Washington DC: National Academies Press.

    Google Scholar 

  52. Starfield, B. (2004). U.S. child health: What’s amiss, and what should be done about it? Health Affairs, 23, 165–170.

    PubMed  Article  Google Scholar 

  53. Starfield, B., & Shi, L. (2004). The medical home, access to care, and insurance: A review of evidence. Pediatrics, 2004, 1493–1498.

    Google Scholar 

  54. Stevens, G. D., Seid, M., Pickering, T. A., Tsai, K. Y. (2009) National disparities in the quality of a medical home for children. Maternal and Child Health Journal (Epub ahead of print).

  55. Starfield, B. (2008). Access, primary care, and medical home: Rights of passage. Medical Care, 46, 1015–1016.

    PubMed  Article  Google Scholar 

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Author information

Affiliations

  1. Department of Family Medicine, Oregon Health and Science University, 3181 Sam Jackson Park Rd, mailcode: FM, Portland, OR, 97239, USA

    Jennifer E. DeVoe

  2. Oregon Health and Science University, 3181 Sam Jackson Park Rd, Portland, OR, 97239, USA

    Carrie J. Tillotson

  3. Department of Family Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, U-67, Knoxville, TN, 37920, USA

    Lorraine S. Wallace

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

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DeVoe, J.E., Tillotson, C.J. & Wallace, L.S. Insurance Coverage Gaps Among US Children with Insured Parents: Are Middle Income Children More Likely to Have Longer Gaps?. Matern Child Health J 15, 342–351 (2011). https://doi.org/10.1007/s10995-010-0584-9

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  • DOI: https://doi.org/10.1007/s10995-010-0584-9

Keywords

  • Child health
  • Health insurance
  • Discontinuous health insurance coverage
  • Access to healthcare
  • Medicaid
  • SCHIP
  • Health policy