A new retrospective study of children’s health insurance coverage found that about one in five children did not have adequate health insurance, meaning coverage that met their needs and was reasonably affordable.
Researchers from Columbia University, the University of Michigan and Vanderbilt University conducted a study of children’s health insurance coverage between 2016 and 2021.
Of the more than 200,000 children included in the study, 34.5 percent had public health insurance and 65.5 percent had commercial insurance.
The researchers looked for instances of inconsistent coverage or gaps in coverage in the previous 12 months. They also looked at whether children had insurance that did not provide benefits that met the child’s needs, did not allow the child to see a health care provider when needed, or required annual out-of-pocket payments that were not always reasonable.
Only 4.2 per cent of children with public coverage and 1.4 per cent of children with commercial coverage had inconsistent coverage. However, children with public health coverage were less likely to experience inadequate coverage, with 12.2 percent experiencing this problem, compared to 33 percent of children with commercial coverage.
“Using nationally representative data, we found that inconsistent coverage is three times higher among publicly insured children than among commercially insured children,” the researchers concluded.
“However, inadequate coverage is more common overall, affecting nearly one in five children (16.5 million annually) in the US, with particularly high rates among the commercially insured.”
Regardless of the type of coverage they had, most children in the study – more than 95 per cent – reported having a plan that “always” or “usually” allowed them to see a doctor.
The main difference between public and commercial plans for children appeared to be in annual out-of-pocket costs. Among those with public insurance, 92.2 per cent reported that their out-of-pocket costs were usually reasonable. In comparison, 67.6 per cent of children with commercial coverage reported the same, and 31.3 per cent reported annual out-of-pocket costs that were “never” reasonable.
The study also found that both the consistency of public coverage and the adequacy of commercial coverage improved “significantly” during the COVID-19 public health emergency. With the end of the public health emergency and the rollback of expanded eligibility, millions of children – estimated at more than 5 million – are expected to lose coverage.
The researchers said their study points to the need for “renewed attention and investment in policies to improve insurance adequacy”. They also pointed to “promising” policy options available to states that would allow children to maintain coverage, including a Centers for Medicare & Medicaid Services rule that allows states to provide 12 months of continuous Medicaid-CHIP eligibility for children. Only 23 states have implemented this policy as of January 2023.
