Millions of children in America have inadequate health care coverage

Inadequate health coverage is a particular problem for commercially insured children, according to a new study released by the Columbia University Mailman School of Public Health. Research shows that coverage gaps are affecting publicly insured children as well. Until now, prior research had focused on documenting rates and trends in insurance stability for children covered by all types of insurance. The findings have been published JAMA Health Forum,

Jamie Daw, PhD, assistant professor of health policy, said while uninsured rates among children in the U.S. are generally declining, our results highlight the need for a renewed focus on ensuring That children’s coverage is affordable for families and provides children with the benefits they need. and Management at the Columbia Mailman School of Public Health.

Using representative data from the 2016-2021 National Survey of Children’s Health, researchers analyzed information provided by a parent or caregiver on health insurance data for children over 17 and looked at inconsistent and Also compared changes during COVID-19, identifying inadequate coverage. Type.

Inadequate insurance was defined by a failure to meet three criteria: benefits were sufficient to meet the child’s needs; Coverage allows the child to see needed health care providers; and lack of reasonable annual out-of-pocket payment for children’s health care.

Uninsured coverage was three times higher among publicly insured than commercially insured children. However, overall inadequate insurance was more prevalent, affecting approximately one in five American children (16.5 million annually), with rates particularly high among the commercially insured. The researchers also found that child and family characteristics associated with higher rates of inconsistent and inadequate coverage vary by insurance type.

Of the sample of 203,691 insured children, 34.5 percent were publicly insured and 65.5 percent were commercially insured. Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2 vs. 1.4%) and lower rates of inadequate coverage (12 vs. 33%). Compared to 2016-19, inadequate insurance for publicly insured children decreased by 42 percent and inadequate insurance for commercially insured children decreased by 6 percent during COVID.

In summary, the findings suggest:

One in five children in the United States has inadequate health insurance, meaning insurance that either has unreasonable out-of-pocket costs or does not provide benefits that meet the child’s medical needs.

Inadequate coverage is especially high among children with commercial insurance (about 1 in 3 commercially insured children versus 1 in 10 publicly insured children).

Insurance gaps (i.e. periods without coverage) are more common for publicly insured children.

Both commercial insurance adequacy and the public insurance gap decreased significantly during the COVID-19 pandemic, when additional subsidies for commercial insurance and requirements for states to keep Medicaid beneficiaries enrolled were in place.

With post-COVID protections set to expire in 2023, many publicly insured children are losing coverage which would reverse the gains in consistent coverage seen during the pandemic.

More efforts need to be done to protect commercially insured families from high out-of-pocket costs for children’s health care and to ensure that benefit/provider networks are designed to meet children’s needs. Are enough.

Additionally, Dow and colleagues note that there is a particular need for state Medicaid programs to conduct targeted outreach and linguistically and culturally competent navigation assistance for immigrant families.

Federal COVID-19 relief policies prevented states from disenrolling children on Medicaid and established increased subsidies for private marketplace coverage. The findings of our study show that these policies made a significant difference for families during the pandemic: coverage gaps were smaller for publicly insured children and coverage was more affordable for commercially insured children. Dr said policymakers should actively consider how to maintain and extend these gains.

Co-authors are Sarah Yekta, Columbia Mailman School of Public Health; Phelan Jacobson-Davis and Lindsay Edman of the University of Michigan; and Stephen Patrick, Vanderbilt University Medical Center

The study was funded by the Agency for Healthcare Research and Quality (R01HS029159).

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