Changes in Health Insurance Coverage and Health Status: Children

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To measure health insurance coverage, the NSAF asks about multiple sources of coverage and follows with a verification question to confirm lack of coverage among those who do not identify a source. Coverage is measured at the time of the survey, defined using a hierarchy, and then grouped into four categories: employer-sponsored insurance (including coverage through the military); Medicaid, SCHIP or another state program; other (including coverage through private insurance, Medicare or other coverage of an unspecified type); and uninsur-ance. The estimates presented here differ slightly from those presented in the work of Zuckerman and Kenney, Haley and Tebay, which include 18-year-olds as children and not as adults.

Overall, the health insurance coverage of children improved between 1997 and 2002, with a drop in uninsurance from 12.1% to 9.5% (Table 1). Although employer-sponsored coverage declined during this period, this change was more than offset by the simultaneous expansion of public coverage under Medicaid and SCHIP. These trends in employer-sponsored coverage, public coverage and uninsurance held for both black and white children. Hispanic children saw no significant changes in employer-sponsored insurance and uninsurance over this period. The share of Hispanic children with public coverage, however, did increase. online pharmacy no prescription needed

Table 1. Children’s Health by Race, Ethnicity and Income, 1997-2002

Variables	1997	Black 2002	Hispanic 1997    2002		White 1997   2002		1997	All 2002
Health Insurance Coverage
All incomes
Employer-sponsored	50.2	44.5*	43.4	40.3	76.0	74.2*	66.3	63.4*
Medicaid/SCHIP	34.3	44.2*	30.8	36.7*	10.1	14.5*	17.5	23.2*
Other	2.3	2.5	2.7	2.7	5.0	4.7	4.1	4.0
Uninsured	73.2	8.8*	23.1	20.2	8.9	6.6*	12.1	9.5*
Low income
Employer-sponsored	3J.2	23.6*	25.5	21.7*	48.5	42.9*	37.7	31.8*
Medicaid/SCHIP	49.3	63.2*	41.9	50.9*	27.4	39.7*	36.7	48.8*
Other	2.6	2.4	2.7	2.2	5.6	4.7	4.1	3.3
Uninsured	16.8	10.8*	29.8	25.2*	18.6	12.7*	21.5	16.1*
Higher income
Employer-sponsored	84.5	72.9*	83.1	71.0*	89.0	85.5*	88.2	82.6*
Medicaid/SCHIP	7.1	J8.6*	6.1	13.4*	1.9	5.4*	2.7	7.6*
Other	1.8	2.5	2.8	3.5	4.8	4.8	4.1	4.4
Uninsured	6.6	6.0	8.0	12.1*	4.3	4.4	5.0	5.4
Health Status
Fair or poor
All incomes	5.9	6.4	11.5	10.6	2.7	2.6	4.6	4.7
Low income	7.3	8.7	15.6	13.6	5.3	4.6	8.3	8.3
Higher income	3.6	3.4	2.4	5.6*	1.5	1.9	1.8	2.6*
Size of Sample (N)	5,274	4,382	5,097	6,146	22,777	22,492	34,439	34,332
Sources: 1997 and 2002 National Survey of America’s Families Notes: “Black” and “white” include non-Hispanics only; “Hispanic” includes all races. “All” includes American Indian/Alaska Native, Asian/Pacific Islander, black, Hispanic and white. Children are age 17 and younger. Bold indicates that black or Hispanic estimate is significantly different from the estimate for whites at the 0.05 level. Italics indicate that black estimate is significantly different from the estimate for Hispanics at the 0.05 level. Estimates for 1997 use new weights based on the 2000 Census and may differ from previously published estimates using weights based on the 1990 Census. * Difference from 1997 is significant at the 0.05 level.

Children in both low-income and higher-income families benefited from the expansion of public health insurance coverage. Public coverage of children in low-income families increased by 12 percentage points between 1997 and 2002, with about half of Hispanic children and two-thirds of black children covered in 2002. Public coverage of children in higher-income families rose by approximately five percentage points, with statistically significant increases in all three racial or ethnic groups.
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The decline in uninsurance was concentrated among children in low-income families. For these children, the increase in public coverage more than compensated for the decline in employer-sponsored insurance obtained through their parents. Black and white low-income children had the greatest declines in uninsurance, at approximately six percentage points each, followed by Hispanic low-income children, with a decline of about five percentage points.

Among higher-income children in general, the rise in public coverage also offset the decline in employer-sponsored coverage, but not enough to reduce uninsurance. Between 1997 and 2002, the uninsurance rates for black and white children in higher-income families changed little. Among Hispanic higher-income children, however, public coverage did not increase enough to make up for the drop in employer-sponsored insurance, resulting in a four percentage point increase in uninsurance.

As part of their NSAF interviews, parents were asked whether their children’s health was excellent, very good, good, fair or poor. Analysis of the data indicates that the overall gain in insurance coverage for children over this period was not accompanied by improved health status. The share of children reported to be in fair or poor health did not change significantly for black, Hispanic or white children, or for children overall. The only significant change in health status occurred among higher-income Hispanic children, who were more likely to be in fair or poor health in 2002 than in 1997. Notably, these children were the only group more likely to be uninsured in 2002 than in 1997.
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Racial and ethnic disparities in children’s health insurance coverage and health status continue despite overall gains in insurance coverage. Between 1997 and 2002, Hispanic children were more likely to be uninsured and more likely to be in fair or poor health than black or white children. Some of the disparity in health status may be due to the use of respondent (parent) reporting; other studies have shown that His-panics tend to report poorer health, relative to other indicators, than other respondents. Black children were more likely to be uninsured and more likely to be in fair or poor health than white children.

Breaking down these findings by family income reveals more about the situations of both black and Hispanic children. In 2002, Hispanic children in both low-income and higher-income families were significantly more likely to be uninsured than their black or white counterparts, suggesting that the disparity between Hispanic and black or white children is not attributable to differences in income levels. In contrast, the uninsurance rate for low-income black children was not significantly different from that of low-income white children, and the uninsurance rate for higher-income black children was not significantly different from that for higher-income white children. These comparisons suggest that differences in the family incomes of black and white children are the main source of the differences in their uninsurance rates. White children in both income groups were more likely than their black or Hispanic counterparts to have employer-sponsored insurance, while black and Hispanic children in both income groups were more likely than white children to be insured through Medicaid or SCHIP. kamagra soft tabs

Combining the distribution of health insurance coverage and reported health status reveals further evidence that Hispanic children are at a greater disadvantage than other children. In 2002, approximately 570,000 children were both uninsured and in either fair or poor health. More than two-thirds of those children were Hispanic, yet according to the NSAF, Hispanic children accounted for less than one-fifth of all children in the United States. Black children are also over-represented among this group: they made up 15.9% of all children nationally, but 19.1% of the children who were both uninsured and in fair or poor health.