Cross-sectionally, 77.4% of children in the United States were insured with at least one insured parent (unweighted n=27,528) and 8.5% were uninsured with uninsured parents (unweighted n=4,236). Insured children with uninsured parents represented approximately 10.8% of the population (unweighted n=6,444), and 3.3% of children had the discordant pattern of interest in this study: uninsured child with at least one insured parent (unweighted n=1,380, representing, when weighted, an average annual population of over 2.3 million children). In full-year estimates, 4.1% of children with a parent insured all year had a health insurance coverage gap (unweighted n=1,716, average weighted annual population of nearly 3 million). An estimated 1.6% of these children were uninsured for the entire year (unweighted n=653, average weighted annual population of over one million) (). The weighted cross-sectional estimates suggest that at any point-in-time, over a quarter of uninsured children in the US between 2002 and 2005 had at least one parent with health insurance coverage.
Prevalence of Different Patterns of Family Health Insurance Coverage in the United States (2002-2005)
Characteristics Associated with a Lack of Health Insurance Coverage Among Children with an Insured Parent
Among children with an insured parent, the distribution of certain demographic and socioeconomic characteristics was different when comparing the insured versus the uninsured children (). At one point in time, a higher percentage of uninsured children (21.9%) were from low-income families, compared to those with insurance coverage (13.2%). In contrast, a lower percentage of uninsured children (21.7%) were in high-income families as compared to the percentage insured (33.9%). Nearly a quarter of uninsured children were of Hispanic origin (24.7%), compared to only 14.2% of the insured children. The percentage of uninsured children living in single-parent households (39.9%) was also significantly higher than the percentage of insured children (25.3%). Higher percentages of uninsured children lived in the South (39.5%) or the Western United States (29.9%) as compared with insured children in the South (32.6%) or the West (23.4%). There was a higher percentage of insured children with excellent health status (49.8%), compared with uninsured (44.7%), and 88.1% of insured children had at least one parent who had completed high school as compared with only 80.3% of uninsured children. These patterns persisted when comparing insured versus uninsured children in the full-year analyses.
Demographic Characteristics of US Children with at Least One Insured Parent, According to the Child’s Health Insurance Status (2002-2005)
Health Insurance Discordance: Uninsured Children with Covered Parents
shows the cross-sectional and full year multivariable comparisons revealing several factors that were consistently associated with a higher likelihood that the child was uninsured, despite having at least one parent in the household with coverage. Cross-sectionally, children experiencing this discordant pattern of family coverage were more likely Hispanic (odds ratio [OR] 1.58; 95% confidence interval [CI], 1.23 to 2.03) compared to white, non-Hispanics; low and middle income (OR 2.02; 95% CI, 1.42 to 2.88 and OR 1.48; 95% CI, 1.09 to 2.03, respectively) compared to high income; from single-parent homes (OR 1.99; 95% CI 1.59 to 2.49) compared to children living with two married parents; and living with parents who had less than a high school education (OR 1.44; 95% CI 1.10 to 1.89) compared to those with at least one parent who had completed high school. Children whose parents had public coverage were less likely to be uninsured (OR 0.64; 95% CI 0.43 to 0.96) compared to those whose parents reported private health insurance. These patterns persisted throughout full-year models.
Predictors of Uninsurance Among Children in the United States with at Least One Parent Insured, Cross-sectional and Full Year 2002-2005)
While the disparities in insurance coverage associated with ethnicity and parental educational attainment were not surprising, it was more interesting to note that low and middle income children were more vulnerable than the poorest and the richest subgroups in full-year analyses. For example, compared to high income children (reference group = 1.00), low income children were more likely to lack health insurance coverage for greater than 6 months (OR 1.73; 95% CI 1.18 to 2.55). Children from middle income families were also more likely than those from high income families to have long coverage gaps (OR 1.56; 95% CI 1.11 to 2.19). Middle income children were the most likely to have gone all year without coverage (OR 1.48; 95% CI 1.00 to 2.19). Although not evident at a point-in-time or all year, children from the two poorest groups were more likely than high income children to experience a coverage gap (OR 1.69; 95 % CI 1.11 to 2.59 for poor families; OR 2.15; 95% CI 1.33 to 3.49 for the near poor).
Parental type of coverage was also associated with different rates of children’s coverage. Compared to children whose parents had any private insurance (reference group = 1.00), those whose parents had only public insurance were less likely to be uninsured at a point-in-time (OR 0.64; 95% CI 0.43 to 0.96), to have any length coverage gap (OR 0.54; 95% CI0.37 to 0.78), and to have a coverage gap greater than six months of the year (OR 0.59; 95% CI 0.35 to 0.98). In the post-hoc analyses focusing on children whose parents reported only private coverage for the full 12 months of a given year, the predictors of children’s uninsurance were similar ().
Predictors of Uninsurance Among Children in the United States with at Least One Parent Privately Insured, Cross-sectional and Full Year (2002-2005)