Maternal and Child Health Journal

, Volume 18, Issue 4, pp 1007–1016 | Cite as

Recent Health Insurance Trends for US Families: Children Gain While Parents Lose

  • Jennifer E. DeVoe
  • Carrie J. Tillotson
  • Heather Angier
  • Lorraine S. Wallace


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.


Health 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.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jennifer E. DeVoe
    • 1
    • 2
  • Carrie J. Tillotson
    • 1
  • Heather Angier
    • 1
  • Lorraine S. Wallace
    • 3
  1. 1.Oregon Health & Science UniversityPortlandUSA
  2. 2.OCHINPortlandUSA
  3. 3.The Ohio State UniversityColumbusUSA

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