According to an analysis led by researchers at the University of Pittsburgh School of Medicine, a worrying trend in U.S. children’s health has seen the number of underinsured youth rise from 30.6% to 34% — an additional 2.4 million children — from 2016 to 2019.
In the study, published today in Pediatrics, the researchers found that children’s underinsurance was primarily caused by higher rates of inadequate insurance rather than an increase in absent or inconsistent insurance. In particular, they found that families with children with special needs and private insurance were hit particularly hard.
The main conclusion is that the insurance landscape is getting darker and hurting millions of families, especially those who are most vulnerable. We need pediatric organizations and politicians to bring childhood health insurance to the forefront and make it a priority.”
Justin Yu, MD, lead author of the study and assistant professor of pediatrics, Pitt’s School of Medicine
To understand trends in child insurance, Yu and his team analyzed data from the National Survey of Children’s Health, an annual survey of the physical and mental health of newborns through 17-year-olds. They defined underinsured children as those who do not have ongoing and adequate health insurance, where “adequate” means that insurance usually or always met a child’s needs, enabled children to see needed caregivers, and protected from what parents believe unreasonable out-of-pocket expenses.
The increase in the number of underinsured children was caused by the increasing inadequacy of insurance, which was mainly experienced as high out-of-pocket expenditure on health services. This is worrying, the researchers say, because high reimbursements can force families to delay or forego caring for their child.
“Access to health care helps children be as healthy as possible so they can live full and complete lives,” said senior author Amy Houtrow, MD, Ph.D., MPH, professor and vice chair of physical medicine and rehabilitation and pediatrics at Pitt’s School of Medicine, and chief of pediatric rehabilitation medicine at UPMC Children’s Hospital in Pittsburgh. “I don’t believe a family should have to choose between paying for medical care for their child or putting food on the table or paying their electric bill.”
The researchers suspect that the rise in unreasonable out-of-pocket expenses reflects broad trends in the insurance landscape: insurers are increasingly transferring costs to individuals and families through higher deductibles and premiums and, increasingly, through high deductible plans. . These trends may help explain the finding that children with private health insurance were more likely to be underinsured than children with public plans, such as Medicaid or Children’s Health Insurance Program (CHIP).
Another notable finding was an increase in the rate of underinsurance among children considered to be more socio-economically advantaged: white children from highly educated, middle-income families.
“We feel that if you have a full-time job with your employer’s health insurance, your healthcare needs will be met,” Houtrow says. “But our data shows that that is increasingly not the case, especially for families who may be enrolled in lower-premium, high-deductible plans.”
The researchers also examined underinsurance rates in children with chronic health conditions. They found that children with more complex special needs were more likely to be underinsured than children with less complex or no special needs.
“This is worrisome because by definition, these children need the most health care,” Yu says.
Addressing the problem of childhood underinsurance may require large-scale policy reforms, such as broadening Medicaid eligibility or creating a universal health insurance program for all U.S. children. But smaller policy changes, such as making it easier to apply for Medicaid or money aid programs and staying to cover out-of-pocket expenses, can also help.
“Rather than providing a clear policy prescription, the aim of this study is to bring the issue of child underinsurance to the forefront of national discussion,” Yu said. “Once people talk about this problem, we can start thinking about policies to address it.”
“We know there are many ways to improve health insurance adequacy for children, and this study tells us that now is the time to continue on that journey,” Houtrow added.
Yu, J., et al. (2021) Childhood underinsurance in the United States. pediatrics. doi.org/10.1542/peds.2021-050353.
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