Recent Health Insurance Trends for US Families: Children Gain While Parents Lose
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In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine—qualitatively and quantitatively—the impact of changing health insurance coverage on US families. Primary data from interviews with Oregon families (2008–2010) were analyzed using an iterative process. Qualitative findings guided quantitative analyses of secondary data from the nationally-representative Medical Expenditure Panel Survey (MEPS) (1998–2009); we used Joinpoint Regression to assess average annual percent changes (AAPC) in health insurance trends, examining child and parent status and type of coverage stratified by income. Interviewees reported that although children gained coverage, parents lost coverage. MEPS analyses confirmed this trend; the percentage of children uninsured all year decreased from 9.6 % in 1998 to 6.1 % in 2009; AAPC = −3.1 % (95 % confidence interval [CI] from −5.1 to −1.0), while the percentage of parents uninsured all year rose from 13.6 % in 1998 to 17.1 % in 2009, AAPC = 2.7 % (95 % CI 1.8–3.7). Low-income families experienced the most significant changes in coverage. Between 1998 and 2009, as US children gained health insurance, their parents lost coverage. Children’s health is adversely affected when parents are uninsured. Investigation beyond children’s coverage rates is needed to understand how health insurance policies and changing health insurance coverage trends are impacting children’s health.
KeywordsHealth insurance Access to care Health services research Health policy Health care disparities Children’s health care
This project received direct support from Grant Number R01 HS018569 from the Agency for Healthcare Research and Quality (AHRQ) and the Oregon Health & Science University Department of Family Medicine. We also wish to thank our colleagues in the Oregon Office for Health Policy and Research and the Division of Medical Assistance Programs. We are also extremely grateful to the parents who shared their time and insights with us. 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.
- 1.US Department of Health and Human Services. SCHIP Evaluation (2001). http://aspe.hhs.gov/health/schip/pl105-33.htm. Accessed 11 Oct 2012.
- 3.Ryan, J. (2009). The children’s health insurance program (CHIP): The fundamentals. Washtington, DC: The George Washington University.Google Scholar
- 4.The Henry J. Kaiser Family Foundation. Children’s Coverage and SCHIP Reauthorization (2009). http://www.kaiseredu.org/Issue-Modules/Childrens-Coverage-and-SCHIP-Reauthorization/Background-Brief.aspx. Accessed 11 Oct 2012.
- 5.111th Congress. Compilation of Patient Protection and Affordable Care Act (2010). http://docs.house.gov/energycommerce/ppacacon.pdf. Accessed 16 Dec 2011.
- 6.Kaiser Commission on Medicaid and the Uninsured. Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Kaiser Family Foundation, Washington, DC (2009). http://www.kff.org/medicaid/upload/7863.pdf. Accessed 14 Jan 2011.
- 7.US Department of Health and Human Services (2012). The health care law & you: What’s changing when. http://www.healthcare.gov/law/timeline/index.html. Accessed 2 Feb 2012.
- 8.Zhang, W., & Cresswell, J. (2012). The use of “mixing” procedure of mixed methods in health services research. Medical Care. 13 Jan 2012 (Epub ahead of print).Google Scholar
- 10.Angier, H., DeVoe, J. E., Tillotson, C.J., Wallace, L., & Gold, R. (2012). Trends in Health Insurance Status of US Children and their Parents, 1998–2008. Maternal and Child Health Journal. 27 Sep 2012. (Epub ahead of print).Google Scholar
- 18.Crestwell, J. W. (2007). Qualitative inquiry & research design: Choosing among five approaches (2nd ed.). Thousand Oaks, California: Sage Publications, Inc.Google Scholar
- 24.MacQueen, K. M., et al. (1998). Codebook development for team-based qualitative analysis. Cultural Anthropology Methods Journal, 10(12), 31–36.Google Scholar
- 25.Agency for Healthcare Research and Quality (2004). MEPS HC-089: 2004 Full Year Consolidated Data File. http://www.meps.ahrq.gov/mepsweb/data_stats/download_data/pufs/h89/h89doc.pdf. Accessed 10 Jan 2008.
- 26.Cohen, J.W., Monheit, A.C., Beauregard, K.M., et al. (1996). The Medical Expenditure Panel Survey: a national health information resource. Inquiry, Winter:373-89.Google Scholar
- 30.DeVoe, J. E., Dodoo, M. S., Phillips, R. L., & Green, L. A. (2005). Graham Center one-pager: Who will have health insurance in 2025? American Family Physician, 72(10), 1989.Google Scholar
- 31.Kaiser Family Foundation and Health Research & Educational Trust. Employer health benefits 2012 annual survey (2012). http://ehbs.kff.org/?page=abstract&id=1. Accessed 11 Oct 2012.
- 32.Lavarreda, S. A., Brown, E. R., Cabezas, L., & Roby, D. H. (2010). Number of uninsured jumped to more than eight million from 2007 to 2009. Policy Brief UCLA. Center for Health Policy Research, (PB2010-4):1–6.Google Scholar
- 33.Christanson, J. B., Tu, H. T., & Samuel, D. R. (2011). Employer-sponsored health insurance: down but not out. Issue Brief (Center for Studying Health System Change), 137, 1–5.Google Scholar
- 36.Kaiser Commission on Medicaid and the Uninsured (2003). States Respond to Fiscal Pressure: State Medicaid Spending Growth and Cost Containment in Fiscal Years 2003 and 2004. Results from a 50-State Survey. http://www.kff.org/medicaid/upload/States-Respond-to-Fiscal-Pressure-State-Medicaid-Spending-Growth-and-Cost-Containment.pdf. Accessed 3 Aug 2011.
- 48.Kenney G, Dubay L, Zuckerman S, Huntress M. Making the Medicaid Expansion an ACA Option: How Many Low-Income Americans Could Remain Uninsured 2012; June 29.Google Scholar
- 50.The Henry J. Kaiser Family Foundation. (2012, August). Implementing the ACA’s medicaid-related health reform provisions after the supreme court’s decision. Focus on Reform (8348).Google Scholar
- 51.US Department of Health and Human Services (1998). Annual Update of the HHS Poverty Guidelines. Federal Register, 63(36): 9235–9238.Google Scholar
- 52.US Department of Health and Human Services (2009). Annual Update of the HHS Poverty Guidelines. Federal Register, 74(14): 4199–4201.Google Scholar