Nav: Home

Poor kids' health insurance situation changes often, affecting their medical care, study finds

May 20, 2004

ANN ARBOR, Mich. - Amid the flood of recent news about America's uninsured, a new study finds a troubling undercurrent: millions of low-income children whose health care gets interrupted because they start the year with one kind of insurance, but end it with another kind -- or go without any coverage at all for part of the year.

More than 5.7 million low-income children may experience a transition in their health insurance sometime during each year, the University of Michigan study finds. They may shift to or from being uninsured, or may join or leave private insurance policies and public programs like Medicaid, as their family income or situation changes.

And, the study finds, low-income kids who experience these changes in their coverage each year are more likely to postpone doctor visits and prescriptions, to go a year without seeing a doctor, or to be in fair or poor health.

The study is the first to show a link between health insurance transitions and child health care trends. It's published in the May issue of Ambulatory Pediatrics by a team from the Child Health Evaluation and Research Unit of the U-M Medical School's Department of Pediatrics and the U-M Health System's C.S. Mott Children's Hospital.

"The uninsured in America are not a homogenous group, but a rather mixed group, with some children and families remaining uninsured for a long time and others becoming uninsured more recently, or finding a new source of insurance after being without coverage for some period of time," says senior author and assistant professor Matthew Davis, M.D., MAPP. "These data show a lot of coverage transitions for low-income children, affecting one in every five of them each year. And the data indicate that these transitions can disrupt children's access to health care."

The study is based on an analysis of the Urban Institute's National Survey of America's Families, using data from 1999, the most recent year for which survey results are available. The survey asked the parents of nearly 36,000 children in 13 states about their child's insurance status in the last year, health status and medical care, and demographic characteristics.

More than a third of the families had incomes that fell below twice the poverty level, the group most likely to be eligible for public insurance programs. The survey sample was weighted so that results could be extrapolated to the entire U.S. population.

"If the trends we see were true in 1999, when the economy was healthy and states had just developed new SCHIP public insurance programs for low-income children, we can only speculate what has happened in recent years since the economic downturn and state budget crises hit," says Davis, who hopes to analyze data from 2002 when they become public later this year.

In recent years, some states have scaled back enrollment in Medicaid and State Children's Health Insurance Programs (SCHIP), or implemented new requirements for renewal of benefits that can act as barriers to continuous coverage. Meanwhile, many families have lost private insurance coverage as employers lay off workers or pass more of their benefit costs on to employees.

The U-M authors say their findings point to a need to increase, and then maintain, enrollment in public insurance programs designed for low-income children whose families don't have employer-sponsored health insurance and can't afford to buy their own. Only consistent coverage and minimized barriers such as income recertification will give these children the best chance at getting needed care.

"We found that families are postponing care for their children, likely until they can make the transition from being uninsured to having some form of coverage," says Davis, who notes that some insurance programs have waiting periods before new enrollees can begin to use their benefits. Postponing needed care because of a lack of insurance may mean that a child doesn't get regular checkups for asthma, or doesn't get a refill for his or her medications.

"Intermittent periods of insurance coverage are not sufficient to meet children's medical needs, even when adjusted for health status," adds Davis. "Gaps in coverage, whether preceded or followed by coverage, are barriers to adequate health care."

The researchers did find some evidence that eligible children were being enrolled in public programs for which they qualified because of family income. For instance, 5.4 percent of the children under 5 years of age at the time of the survey were enrolled in public insurance programs but had been uninsured sometime in the last year. In all, the researchers estimate that 1.3 million low-income children went from being uninsured to being covered by public insurance programs during the year leading up to the survey.

But then again, 4.6 percent of the children under 5, and an estimated 1.2 million children nationwide, had gone from public insurance to being uninsured in the same time period.

Barriers to re-enrollment in Medicaid or SCHIP, or changes in family income that put children just over the income eligibility limit for coverage, might be the cause, Davis suggests. Whatever the reason for their dropping out of the public system, their lack of insurance meant they were more likely to have care postponed.

The barriers to enrollment in public programs were erected partly to fend off an effect called "crowd out," in which some low-income families were expected to drop their private insurance coverage for their children in order to enroll them in SCHIP public insurance programs.

Davis and his colleagues saw little evidence of crowd-out: three times more children moved from public to private insurance during the year before the survey than moved from private to public.

Some children transitioned from one public insurance program to another, for example from Medicaid to SCHIP as their family income increased. But even such a transition can affect health care, Davis notes. He recently had a young patient stop coming to him for care because the SCHIP plan his family chose after their income rose too high for Medicaid didn't have a contract with U-M.

When the researchers looked at health insurance transition trends among different demographic groups, they found that non-Hispanic black children, and children whose parents did not have a partner or spouse, were more likely than other children to have experienced a transition. But Hispanic children were far less likely to have had a transition - in fact, almost 27 percent of Hispanic children had been uninsured for the entire past year, echoing previous findings of high rates of uninsurance in this ethnic group.

In addition to Davis, the study's authors are Kimberly Aiken, M.D., Ph.D., a clinical instructor of pediatrics who led the analysis during her fellowship; and Gary Freed, M.D., M.P.H., chief of the Division of General Pediatrics and director of the CHEAR unit.
-end-


University of Michigan Health System

Related Health Care Articles:

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.
Mental health outcomes among health care workers during COVID-19 pandemic in Italy
Symptoms of posttraumatic stress disorder, depression, anxiety and insomnia among health care workers in Italy during the COVID-19 pandemic are reported in this observational study.
Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.
MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).
Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.
International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.
The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .
Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.
High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.
Medical expenditures rise in most categories except primary care physicians and home health care
This article was published in the July/August 2017 issue of Annals of Family Medicine research journal.
More Health Care News and Health Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: The Power Of Spaces
How do spaces shape the human experience? In what ways do our rooms, homes, and buildings give us meaning and purpose? This hour, TED speakers explore the power of the spaces we make and inhabit. Guests include architect Michael Murphy, musician David Byrne, artist Es Devlin, and architect Siamak Hariri.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at Radiolab.org/donate.     You can read The Transition Integrity Project's report here.