Health Care Costs and Financing

Researchers examine trends in children's health insurance coverage and the potential impact of SCHIP

The proportion of children in the United States without health insurance grew substantially from 1977 to 1996. But this increase was predominantly among children from single-parent families, finds a study by Robin M. Weinick, Ph.D., and Alan C. Monheit, Ph.D., of the Agency for Health Care Policy and Research.

A second study by AHCPR researchers Thomas M. Selden, Ph.D., Jessica S. Banthin, Ph.D., and Joel W. Cohen, Ph.D., shows that 2.6 million uninsured children are eligible for coverage under the State Children's Health Insurance Program (SCHIP), but enrolling eligible children depends in large part on States' eligibility rules and outreach efforts. The SCHIP program was initially proposed by President Clinton and launched in 1997 to provide coverage to more uninsured children, specifically those in families with incomes too high to qualify for Medicaid.

The two studies are briefly summarized here.

Weinick, R.M., and Monheit, A.C. (1999, March). "Children's health insurance coverage and family structure, 1977-1996." Medical Care Research and Review 56(1), pp. 55-73.

The researchers found that one in five children in single-parent families was uninsured in 1996, which is one-third more than in 1977. In contrast, the percentage of children in two-parent families with public coverage doubled between 1987 and 1996, from 6 percent to nearly 13 percent. This increase occurred primarily among poor families and those with only one working parent and was consistent with expansions in the Medicaid program during this period. However, it appears that expansion of Medicaid eligibility after 1987 had little impact on children in single-parent families, whose rates of public coverage actually declined during the study period.

The study also finds that having two employed parents living in the same household greatly increased the chances of children having private insurance. These children were less likely to be uninsured than those living in two-parent households with only one working parent or those living in single-parent households.

In addition, in 1996, over 20 percent of privately insured children whose single parent previously had been married received their coverage from a policyholder who did not live with them, most likely the child's other parent. This compares with a 1987 rate of only 5 percent.

Information on family structure can provide an additional gauge for evaluating which children are at increased risk of lacking private insurance or being uninsured and, in turn, can help target public policy interventions in appropriate ways, note Drs. Weinick and Monheit. They analyzed data from three nationally representative medical expenditure household-based surveys conducted by AHCPR in 1977 (National Medical Care Expenditure Survey, NMCES), 1987 (National Medical Expenditure Survey, NMES), and 1996 (Medical Expenditure Panel Survey, MEPS), to examine the relationship between children's family structure and their health insurance coverage. Reprints (AHCPR Publication No. 99-R051) are available from the AHCPR Publications Clearinghouse.

Selden, T.M., Banthin, J.S., and Cohen, J.W. (1999, March). "Waiting in the wings: Eligibility and enrollment in the State children's health insurance program," Health Affairs 18(2), pp. 126-133.

This study by Drs. Selden, Banthin, and Cohen found that 2.6 million uninsured children are eligible for coverage under SCHIP, a program that primarily targets children of the working poor. If these children are added to the 4.7 million uninsured children who were eligible for but not enrolled in Medicaid in 1996, then these public health insurance programs would cover nearly two-thirds of all uninsured children in the United States.

With $24 billion set aside over 5 years, SCHIP is the largest single expansion of health insurance coverage for U.S. children in more than 30 years. The program offers States an enhanced matching rate (up to a capped amount) for enrolled SCHIP children, and gives States the option of expanding traditional Medicaid, creating separate programs, or using combined approaches to implement SCHIP. Also, States that create new SCHIP programs are permitted to impose modest premiums, copayments, and waiting periods (for example, requiring a 3- to 6-month period of uninsurance before eligibility for SCHIP).

The challenge is to get children enrolled via aggressive outreach programs, conclude the researchers. They simulated SCHIP eligibility and enrollment based on an analysis of data on 6,903 children from the 1996 Medical Expenditure Panel Survey.

Reprints (AHCPR Publication No. 99-R050) are available from the AHCPR Publications Clearinghouse.

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