A worrying trend for the health of U.S. children, the rate of underinsured youngsters rose from 30.6 percent to 34%- an additional 2.4 million children- between 2016 until 2019 according to a study led by University of Pittsburgh School of Medicine researchers.
In the study, published today in Pediatrics, the researchers found that underinsurance of children was mainly driven by increased rates of insufficient insurance, not a rise in absent or inconsistent insurance. They found that families with children who had special health care requirements or private insurance were particularly affected.
The main takeaway is that the insurance landscape is becoming worse, and it’s affecting millions of families, specifically those who are the most vulnerable. We require pediatric organizations and politicians to bring child health insurance to the top of the list and make it a top priority issue.”
Justin Yu, M.D. is the lead author of this study and an assistant professor of pediatrics at Pitt’s School of Medicine
Yu and his team used data from the National Survey of Children’s Health to analyze the trends in insurance for children. The annual survey assesses the physical and mental health of children ages newborn to 17. Children who are not insured are those who do not have continuous and adequate insurance. “Adequate” means that insurance provides a minimum level of coverage that fulfills the needs of a child’s health, allows them to see doctors and shields them from unreasonable out-of pocket costs.
The rising inadequacy of insurance was the primary reason for children becoming uninsured. This was due mainly to the high costs out of pocket for health services. According to the researchers, this is concerning because high fees may make families delay or even stop treatment for their child.
“Access to health care can help children be as healthy as they can be so that they can live long and fulfilling lives,” said senior author Amy Houtrow, M.D., Ph.D., M.P.H., professor and vice chair of physical medicine and rehabilitation and pediatrics in Pitt’s School of Medicine, and chief of pediatric rehabilitation services at UPMC Children’s Hospital of Pittsburgh. “I believe that no family should have to choose between paying for medical care for their child, or providing food for their family or paying their electric bills.”
The researchers suspect that the increase in unjust out-of-pocket expenses is indicative of broader trends in the insurance landscape: Insurers are increasingly transferring costs to individuals and families through higher premiums and copays and, increasingly with high-deductible plans. These trends may help explain the fact that children who had private health insurance were more likely be underinsured than those on public plans, such as Medicaid or Children’s Health Insurance Program (CHIP).
Another interesting finding was the rise in underinsurance among children who are thought to be more socioeconomically advantageous: white children from middle income and educated families.
“We have this idea that if you have a full-time job and health insurance through your employer that your health-related needs will be met,” said Houtrow. “But our data show that this is not the case, especially for families enrolled in lower premium, high-deductible plans.”
The researchers also examined the underinsurance rates among children with chronic health conditions. They found that kids who had more complex health requirements were more likely to be underinsured compared to those who had less complex or no special health needs.
“This is worrying because, in the definition of the word these children require the most medical attention,” said Yu.
According to the research, tackling the problem of child underinsurance may require large-scale policy reforms such as broadening eligibility for Medicaid or creating a universal health insurance program for all U.S. kids. However, minor changes to the policy like making it easier for children to apply for Medicaid and to stay on it or implementing cash assistance programs to help cover out-of pocket expenses could prove beneficial.
“Rather than presenting a clear policy prescription, the goal of this study is to bring the issue of child underinsurance to the forefront of the national conversation,” said Yu. “Once people begin to talk about this issue, then we can begin to think about ways to solve it.”
“We know there are many possibilities to improve the adequacy of insurance coverage for children’s health and this study tells us that now is the best time to move forward on this journey,” added Houtrow.
Yu, J., et al. (2021) Underinsurance Among Children in the United States. Pediatrics. doi.org/10.1542/peds.2021-050353.
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