The uninsurance rate for children has fallen steadily since the introduction of the Children’s Health Insurance Program (CHIP) in 1997 and dropped significantly, from 7.1 percent in 2013 to 4.8 percent in 2015, following implementation of key coverage provisions in the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). Using data from a recent National Health Interview Survey (NHIS) (see 18 states showed notable drop in uninsured rate in 2015, February 10, 2016), the Urban Institute examined changes in the share of children age 18 and under without health insurance between 1997 and 2015.
Although the uninsurance rate fell from 14.9 percent to 4.8 percent between 1997 and the first three quarters of 2015 (a drop of 67.9 percent), some groups of children are disproportionately likely to be uninsured, and uninsured children still faced large gaps in health care access, affordability, and service use compared with their insured peers.
Background. The Urban Institute used data from the NHIS survey to track uninsurance counts and rates for children age 18 and under, and by age group (age five and under, ages six to 12, and ages 13 to 18). Children are considered uninsured if they do not have coverage through private health insurance, Medicare, Medicaid, CHIP, military health insurance, or other public insurance at the time of the survey.
Findings. Between 1997 and 2015, the Urban Institute noted that uninsurance was cut more than 60 percent for each of three children’s age groups. Although the uninsurance rates fell between 2013 and 2014 for most of the individual subgroups of children examined, there were still racial/ethnic, socioeconomic, and geographic disparities in coverage. For instance, uninsurance rates fell for Hispanic children and non-Hispanic black children, but 10.3 percent of Hispanic children were uninsured in 2014 compared with 4.2 percent of non-Hispanic white children and 3.7 percent of non-Hispanic black children. In addition, the decline in children’s uninsurance was statistically significant for those who were citizens but not among noncitizen children; nearly 33 percent of noncitizen children were uninsured in 2014 compared with 4.9 percent of citizen children.
For each of the measures of health care access, service use, and affordability examined, children who were uninsured for the 12 months prior to the 2014 survey reported worse access than children who were insured for all of the previous 12 months. Almost 33 percent of uninsured children were in households who had trouble paying their medical bills because of affordability issues and 28.5 percent were reported to have some type of unmet health care need, including medical care, prescription drugs, dental care, eyeglasses, mental health care, follow-up care, or specialist care. In contrast, 17.5 percent of insured children lived in families that had trouble paying their medical bills and 5.2 percent had an unmet need for care because of affordability. In addition, 33 percent of uninsured children did not have a usual place for routine care, whereas 98.2 percent of insured children had a usual source of care. Just under half of uninsured children had a routine checkup and dental visit in the previous year.
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