1 in 5 children in the US have “inadequate” health insurance coverage: Study

A new retrospective study of children’s health care coverage found that roughly 1 in 5 children did not have adequate health insurance, meaning coverage that met their needs and was reasonably affordable.

Researchers from Columbia University, the University of Michigan and Vanderbilt University conducted a study of children’s health insurance coverage between 2016 and 2021.

Of the more than 200,000 children that were included in the study, 34.5 percent had public health coverage, and 65.5 percent were commercially insured.

Researchers looked for instances of inconsistent insurance or gaps in insurance coverage in the past 12 months. They also studied whether children had insurance that did not provide benefits to meet the child’s needs, did not allow the child to see a health care provider as needed or required annual out-of-pocket payments that were not always reasonable.

Just 4.2 percent of children with public coverage and 1.4 percent of children with commercial coverage experienced inconsistent coverage. Children with public health coverage, however, were less likely to experience inadequate coverage, with 12.2 percent having this issue, compared to 33 percent of children with commercial coverage.

“Using nationally representative data, we found that inconsistent coverage is 3 times higher among publicly insured compared with commercially insured children,” the researchers noted.

“However, inadequate insurance is more prevalent overall, affecting nearly 1 in 5 children (16.5 million annually) in the US, with particularly high rates among the commercially insured.”

Regardless of what type of coverage they had, most children included in the study — more than 95 percent — were reported to have a plan that “always” or “usually” allowed them to see a health care practitioner.

The main difference between public and commercial plans for children appeared to be annual out-of-pocket costs. Among those with public coverage, 92.2 percent were reported to typically have reasonable out-of-pocket costs. In comparison, 67.6 percent of children with commercial coverage were reported to say the same, with 31.3 percent reported to have annual out-of-pocket costs that were “never” reasonable.

The study also noted that public insurance consistency and commercial insurance adequacy both improved “substantially” during the COVID-19 public health emergency. With the end of the public health emergency and the unwinding of expanded eligibility, millions of children — estimated to be more than 5 million — are expected to lose coverage.

The researchers said their study indicated the need for “renewed attention and investment in policies to improve insurance adequacy.” They also pointed to “promising” policy options available to states that would allow children to continue having coverage, including a rule by the Centers for Medicare & Medicaid Services that allows states to provide a 12-month continuous Medicaid-CHIP eligibility for children. Only 23 states implemented this policy as of January 2023.