Millions of children in the United States have inadequate health care

Inadequate health care is a particular problem for commercially insured children, according to a new study published by the Columbia University Mailman School of Public Health. The research shows that coverage gaps also affect publicly insured children. Until now, previous research had focused on documenting insurance premiums and trends for children covered by all insurance types. The results have been published in JAMA Health Forum.

While child uninsured rates have declined overall in the U.S., the results show a need to refocus on making sure children’s insurance is affordable for families and provides the benefits children need, said Jamie Daw, PhD, assistant professor of health policy. and leadership at the Columbia Mailman School of Public Health.

Using representative data from the 2016-2021 National Survey of Children’s Health, researchers analyzed parent- or guardian-reported health insurance information for children 17 and older, and also compared changes during COVID-19 and found inconsistent and inadequate coverage in each insurance. type.

Inadequate insurance was defined as failure to meet three criteria: benefits were sufficient for the child’s needs; coverage allows the child to see the health care providers they need; and lack of reasonable annual out-of-pocket payments for children’s health care.

Inconsistent coverage was three times higher for publicly than commercially insured children. However, underinsurance was more common, affecting nearly one in five US children (16.5 million per year), with an especially high rate among the commercially insured. The researchers also found that child and family characteristics associated with higher rates of inconsistent and inadequate coverage varied 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 2016-2019, inconsistent coverage decreased by 42 percent for publicly insured children and inadequate coverage decreased by 6 percent for commercially insured children during COVID.

In summary, the findings show:

In the United States, one in five children has inadequate health insurance, meaning insurance that has prohibitive costs or does not have benefits that meet the child’s medical needs.

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

Insurance gaps (ie periods without insurance) are more common in publicly insured children.

Both commercial insurance adequacy and public insurance gaps were significantly reduced during the COVID-19 pandemic, with additional subsidies for commercial insurance and requirements for states to keep their Medicaid beneficiaries covered.

When coverage ends in 2023 as a result of the COVID virus, many publicly insured children will lose coverage, reversing the steady gains in coverage seen during the pandemic.

More needs to be done to protect commercially insured families from the high out-of-pocket costs of children’s health care and ensure that benefits/provider networks are adequate to meet children’s needs.

In addition, Daw and colleagues note that there is a particular need for state Medicaid programs to implement targeted interventions and linguistically and culturally competent navigation assistance for immigrant families.

The federal COVID-19 relief policy prevented states from leaving children on Medicaid and introduced enhanced subsidies for private Marketplace coverage. Our research results suggest that these policies made a big difference to families during the pandemic: publicly insured children had less coverage and insurance was more affordable for commercially insured children. Policymakers should actively consider how to maintain and build on these benefits, said Daw.

Co-authors include Sarra Yekta, Columbia Mailman School of Public Health; Faelan Jacobson-Davies and Lindsay Admon University of Michigan; and Stephen Patrick, Vanderbilt University Medical Center

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

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