Health Insurance Coverage among Children Ages 3 and Younger and Their Parents: National and State Estimates

HEALTH POLICY CENTER RESEARCH REPORT Health Insurance Coverage among Children Ages 3 and Younger and Their Parents National and State Estimates Jennifer Haley Robin Wang Matthew Buettgens Genevieve M. Kenney December 2017 ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Copyright © December 2017. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image by Tim Meko. Contents Acknowledgments iv Executive Summary v Health Insurance Coverage among Young Children and Their Parents 1 Results 3 How does the health insurance coverage distribution of young children compare with that of older children? 3 How does the health insurance coverage distribution among parents of young children compare with that among parents of older children? 4 How have uninsurance rates changed over time for young children and their parents? 5 How have Medicaid/CHIP coverage rates changed over time for young children and their parents? 6 How have employer and nongroup/other coverage rates changed over time for young children and their parents? 7 How does uninsurance among young children and their parents vary by state? 9 How does Medicaid/CHIP coverage among young children and their parents vary by state? 11 How do the characteristics of young children and their families compare with those of older children and their families? 13 How do the characteristics of young children vary with insurance status? 16 How would uninsurance among young children change if states reduced Medicaid/CHIP eligibility to 138 percent of FPL? 17 How would out-of-pocket burdens among young children change if states reduced Medicaid/CHIP eligibility to 138 percent of FPL? 18 Conclusion 19 Appendix A. Data and Methods 21 American Community Survey 21 Health Insurance Policy Simulation Model (HIPSM) 21 Analysis 22 Limitations 22 Appendix B. Supplemental Tables 24 Notes 31 References 33 About the Authors 36 Statement of Independence 37 IV ACKNOWLEDGMENTS Acknowledgments This brief was funded by the Pritzker Children’s Initiative. We are grateful to them and to all our funders, who make it possible for Urban to advance its mission. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Funders do not determine research findings or the insights and recommendations of Urban experts. Further information on the Urban Institute’s funding principles is available at www.urban.org/support. The authors thank Stephen Zuckerman and Elaine Waxman for their input and Elisabeth Burak and Deborah Stein for their helpful comments and suggestions. EXECUTIVE SUMMARY V Executive Summary Conditions during the earliest years of children’s lives, including access to affordable health care for children and their parents, have both immediate and long-lasting impacts on children’s health and well-being. In particular, health insurance coverage can improve health care access, health, and financial stability for the family ( Howell and Kenney 2012; IOM 2009; Paradise and Garfield 2013; Wagnerman 2017). And reducing uninsurance among parents has been shown to have positive effects on coverage and receipt of care among children, ultimately contributing to children’s healthy development ( Burak 2016, 2017; Hudson and Moriya 2017; Venkataramani, Pollack, and Roberts 2017). This brief focuses on health insurance coverage among young children and their parents at the national and state levels, using data from the American Community Survey (ACS) and the Health Insurance Policy Simulation Model (HIPSM; see appendix A for details on the data and methods). We define young children as those ages 3 and younger. Our main findings are as follows:  Medicaid and the Children’s Health Insurance Program ( CHIP) are important in insuring all children, but young children especially. Of the nation’s 15.7 million young children in 2015, more relied on Medicaid/CHIP than on any other type of insurance coverage, with nearly half (48.8 percent, or 7.7 million) covered by Medicaid/CHIP.  Just 3.5 percent of young children were uninsured in 2015, but 13.2 percent of parents of young children were uninsured, compared with 12.0 percent of parents of older children. Certain family characteristics, such as lower incomes, younger parents, and mixed immigration status, are more prevalent among families of young children, placing them at higher risk of lacking coverage.  The Affordable Care Act (ACA) was associated with increased coverage among young children an