A third of children underinsured, study says

NONA TEPPER / December 06, 2021

A third of children lacked adequate and continuous insurance coverage from 2016 to 2019, a new study says.

The number of underinsured children grew by 2.4 million during the three-year period, bringing the number of kids with inadequate coverage to 23.7 million, according to a paper published in the journal Pediatrics Monday.

Researchers from the University of Pittsburgh School of Medicine analyzed data from the annual National Survey of Children's Health and found the increase was mainly driven by increased rates of inadequate private insurance.

The authors define "inadequate" insurance as coverage not meeting children's' needs, not allowing patients to see their providers and leaving families with high out-of-pocket expenses. This has long-term implications on individuals' health and costs, said Dr. Amy Houtrow, chief of pediatric rehabilitation medicine services at UPMC Children's Hospital of Pittsburgh and the report's lead author.

"It's hard for kids, based on their insurance, to get what they need," Houtrow said. "We know insurance is directly related to that access to care, and we want kids to be able to access the healthcare that they need to be as healthy as possible, so they can be adults who are as healthy as possible."

Families with children who have special health needs and were covered under private insurance were more likely to report that their coverage was inadequate. Thirty-five percent of families whose children had complex conditions said their insurance was inadequate, compared with 25% of those whose children had no chronic condition, the study says.

Immigrant families were also more likely to have inadequate insurance, with 56.5% of children born outside the U.S. being adequately and continuously covered compared to 68.1% of children born in the U.S.

Part of the issue can be attributed to a rise in high-deductible health plans, a broad trend in employer-sponsored coverage, which is how the majority of adults and children receive coverage. Over the past decade, the average deductible employees face rose 92% to $1,434, according to the Kaiser Family Foundation's annual survey of employer coverage. Policies with even higher deductibles are common in the individual insurance market, such as on the health insurance exchanges.

Companies should make sure that the insurance offered to workers covers services that children will need, Houtrow said. "It should be very clear to people who are picking their insurance through their employer that they know what those benefits are for their children," she said.

The House-passed Build Better Act would support continued health coverage for children by permanently funding the Children's Health Insurance Program and by making it harder for children to lose Medicaid benefits over eligibility questions.

Regardless whether children are insured publicly or privately, their ability to access care influences their long-term health and the collective healthcare costs faced by society, said Joan Alker, executive director of Georgetown University's Center for Children and Families.

Medicaid coverage of children and pregnant women is associated with improved health and lower rates of disability in adulthood, higher educational attainment and greater financial security, according to a Commonwealth Fund study.

"It's much more cost effective to offer preventative and early care, it's a good investment as a society," Alker said.