Health Insurance

Narrative

Health insurance is critical for ensuring the health and well-being of children in the United States. Without health insurance coverage, children are less likely to receive medical care and more likely to have poor health status.1 In 2013, more than 4.8 million children under age 18 did not have health insurance. This represents 6.6 percent of all children in the United States. More than half of children (53.2 percent) were covered by private insurance, and 37.7 percent were covered by public insurance (e.g., Medicaid or other state-sponsored health plans including Children’s Health Insurance Program [CHIP]).

Children’s health insurance status varies by several factors, including race, ethnicity, and income. In 2013, nearly 70 percent of non-Hispanic White and non-Hispanic Asian children and more than half of non-Hispanic children of multiple races had private coverage (Figure 1). In comparison, less than half of non-Hispanic Native Hawaiian/Pacific Islander (40.3 percent), non-Hispanic Black (33.6 percent), Hispanic (28.2 percent), and non-Hispanic American Indian/Alaska Native (36.3 percent) children had private coverage. Children with the highest percentage of public insurance were non-Hispanic Blacks (58.8 percent), Hispanics (58.2 percent), non-Hispanic Native Hawaiians/other Pacific Islanders (52.8 percent), and non-Hispanic American Indians/Alaska Natives (49.2 percent). The highest proportions of uninsured children were among non-Hispanic American Indians/Alaska Natives (11.9 percent) and Hispanics (11.8 percent).

health insurance coverage by race

Figure 1 Source

In 2013, households with incomes below 100 percent of poverty had the highest percentage of children with public health insurance (82.3 percent) and the lowest percentage of children with private health insurance (8.4 percent). The highest percent of children who were uninsured in 2013 were children living in households with incomes of 100–199 percent of poverty (11.1 percent), followed by children from households with incomes below 100 percent of poverty (8.2 percent). Children in households with incomes of 200 percent or more of poverty were more likely to have private coverage (81.7 percent) and less likely to have public coverage (11.1 percent) or to be uninsured (4.2 percent), as compared to those in households with lower incomes.

Between 2000 and 2013 there were shifts in the proportion of children in each of the three types of insurance categories (private insurance, public insurance and uninsured). Private health insurance coverage for children is lower in 2013 (53.2 percent) than it was in 2000 (67.0 percent; Figure 2). A larger difference is seen in public health insurance coverage for children which is higher in 2013 (37.7 percent) than it was in 2000 (18.4 percent). The percentage of children who were uninsured in 2013 is nearly half as much as it was in 2000 (6.6 versus 12.4 percent, respectively). Implementation of the Affordable Care Act may further support reductions in uninsurance among children through new electronic data systems that will streamline the eligibility and application process for programs such as Medicaid and CHIP, and by increasing insurance coverage among adults.2 Research has shown that children’s Medicaid and CHIP coverage increases when their parents applied for Medicaid.3

health insurance coverage by year

Figure 2 Source

Data Sources

Figure 1. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey. Analyses conducted by the National Center for Health Statistics.

Figure 2. Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey. Analyses conducted by the National Center for Health Statistics.

Endnotes

1 Szilagyi PG, Schuster MA, Cheng TL. The scientific evidence for child health insurance. Acad Pediatr. 2009 Jan-Feb;9(1):4-6.

2 Urban Health Institute: Health Policy Center. A first look at children’s health insurance coverage under the ACA in 2014. September 9, 2014. Accessed March 2, 2015.

3 DeVoe JE, Marino M, Angier H, et al. Effect of expanding Medicaid for parents on children’s health insurance coverage. JAMA Pediatr. 2015;169(1):e143145. Accessed March 2, 2015.

Data

Statistical Significance Test

Calculate the difference between two estimates:

Calculated Z-Test Result 0.9567433 Not statistically significant

We follow statistical conventions in defining a significant difference by a p-value less than 0.05 where there is a less than 5% probability of observing a difference of that magnitude or greater by chance alone if there were really no difference between estimates. The 95% confidence interval includes a plausible range of values for the observed difference; 95% of random samples would include the true difference with fewer than 5% of random samples failing to capture the true difference.

This website allows comparisons between two estimates using the independent z-test for differences in rates or proportions. This test is appropriate for comparing independent populations across years (e.g., 2011 versus 2012) or subgroups (e.g., Male versus Female) on corresponding measures. To the extent possible, the functionality of this application has limited estimate comparisons based on appropriate use of the independent z-test. However, some tables present subgroup categories within broader categories that will allow comparisons between non-independent populations (e.g., low birth weight and very low birth weight). Users should exercise caution when interpreting these test results, which will frequently overstate statistical significance.

For some tables, the website does not allow for comparisons between two estimates, even though the data represent independent populations. Generally, this is because the standard errors were not publicly available at the time this website was created.

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