Trends in health insurance status of US children and their parents, 1998-2008

Abstract

In the United States (US), a parent's health insurance status affects their children's access to health care making it critically important to examine trends in coverage for both children and parents. To gain a better understanding of these health insurance trends, we assessed the coverage status for both children and their parents over an 11-year time period (1998-2008). We conducted secondary analysis of data from the nationally-representative Medical Expenditure Panel Survey. We examined frequency distributions for full-year child/parent insurance coverage status by family income, conducted Chi-square tests of association to assess significant differences over time, and explored factors associated with full-year insurance coverage status in 1998 and in 2008 using logistic regression. When considering all income groups together, the group with both child and parent insured decreased from 72.4 % in 1998 to 67.2 % in 2008. When stratified by income, the percentage of families with an insured child, but an uninsured parent increased for low-income families from 12.4 to 25.1 % and from 3.8 to 7.1 % for middle-income families when comparing 1998-2008. In regression analyses, family income remained the strongest characteristic associated with a lack of full-year health insurance. As future policy reforms take shape, it will be important to look beyond children's coverage patterns to assess whether gains have been made in overall family coverage.

Fig. 1

Child and parent full-year health insurance coverage status, all income levels, 1998–2008. Source: Medical expenditures panel survey-household component (MEPS-HC), 1998–2008. Full-year insurance status: MEPS-HC assesses insurance coverage status monthly, so we utilized each person’s monthly coverage status to create full-year insurance variables. To be considered insured for the full-year, the child and/or parent(s) had to report having at least 1 day of health insurance coverage in each of 12 months of the calendar year. **For ‘parent’ insurance status, we considered parent(s) insured if at least one parent was insured for the full-year. Parent(s) were uninsured if the sole parent (in single parent households) or both parents were uninsured for some or all of the year

Fig. 2

Child and parent full-year health insurance coverage status, by income level, 1998–2008. Source medical expenditures panel survey-household component (MEPS-HC), 1998–2008. FPL federal poverty level. Full-year insurance status: MEPS-HC assesses insurance coverage status monthly, so we utilized each person’s monthly coverage status to create full-year insurance variables. To be considered insured for the full-year, the child and/or parent(s) had to report having at least 1 day of health insurance coverage in each of 12 months of the calendar year. **For ‘parent’ insurance status, we considered parent(s) insured if at least one parent was insured for the full-year. Parent(s) were uninsured if the sole parent (in single parent households) or both parents were uninsured for some or all of the year. ^#Child insured/parent not insured group estimates unreliable in high-income families due to small number (N <30). Accompanying detail can be found in “Appendix”