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Health Care Coverage
Headline The percentage of all children under age 18 with private health insurance coverage decreased from 71 percent in 2000 to 65 percent in 2006. During the same time period, the percentage of children with Medicaid increased from 20 percent to 27 percent. Eighty-eight percent of children were covered by private or government health insurance in 2006. (See Figure 1) Children not covered by health insurance are less likely than those with insurance to have a regular source of health care and are less likely than the privately insured to have used prescription medicines.1 Children without health insurance are more likely than others to receive late or no care for health problems, putting them at greater risk for hospitalization.2 In addition to less access to health care, a lack of health insurance can also negatively influence children's school attendance and participation in extracurricular activities, and has been found to increase parental financial and emotional stress.3,4 During the late 1990s and early 2000s, health care insurance coverage for children increased somewhat from 85 percent in 1996 to 89 percent in 2003. In 2006, health care coverage was at 88 percent. (See Figure 1) Children's health insurance coverage comes from two major sources-private insurance companies and the government (much of which comes from Medicaid). Medicaid coverage for children increased from 20 percent of all children under age 18 in 2000 to 27 percent in 2006. The percentage of children with private health insurance decreased from 71 percent in 2000 to 65 percent in 2006. (See Figure 1) Differences by Race and Hispanic origin Hispanic children are much less likely than other children to have health insurance coverage. In 2006, only 78 percent of Hispanic children had health insurance coverage, compared with 93 percent of non-Hispanic white children, 89 percent of Asian or Pacific Islander children, and 86 percent of black children. (See Figure 2) A lack of awareness of eligibility, language barriers, enrollment problems, and fear of repercussions for using publicly funded insurance may partially explain why more Hispanic children are uninsured.5 Additional barriers may include ineligibility due to non-citizenship status and Hispanics' lower likelihood to work for employers who offer health insurance.6 Note: Starting with 2002 estimates, the Current Population Survey allows respondents to mark more than one racial category when choosing their race. The 2006 race-specific estimates cited above and throughout this write-up refer to children who were identified as belonging only to one race. These estimates are, therefore, not compatible with estimates before 2002, when only one race could be marked.Differences by Family Type Children in married-couple families are more likely to have health insurance coverage than those in single-parent families, and children in single-father families are the least likely of all family types to have health insurance coverage. In 2006, 90 percent of children in married-couple families had health insurance coverage, compared with 85 percent of children in single-mother families and 79 percent of children in single-father families. (See Table 1) Differences by Income The likelihood of being covered by health insurance increases with income. In 2006, 94 percent of children living in families with incomes of $75,000 or more were covered by health insurance. In contrast, only 82 percent of children in families with incomes of under $25,000 were covered. (See Figure 3) Differences by Nativity and Citizenship Children who are U.S. citizens, whether native-born or naturalized, are more likely than children who are non-citizens to have health insurance coverage. Among children, the health insurance coverage rates in 2006 for U.S. citizens were 89 percent for native-born citizens and 85 percent for naturalized citizens, compared with only 63 percent for non-citizens under age 18. (See Figure 4)
Differences by Type of Health Insurance Coverage In general, children belonging to economically advantaged groups are the most likely to have private health insurance, which is largely employment-based, while children in economically disadvantaged groups are the most likely to have government health insurance,7 which is most often Medicaid, a needs-tested program. Private health insurance covered 65 percent of all children in 2006. Private health insurance coverage is most common among non-Hispanic white children (77 percent), children in married-couple families (74 percent), and children in families with incomes of $75,000 and over (90 percent). Private health insurance is least common among Hispanic children (41 percent), black children (49 percent), children in single-mother families (41 percent), and non-citizens (40 percent). (See Table 2) Although Medicaid covers only about 27 percent of the entire population of children, it covers 66 percent of poor children. Among poor children, Medicaid coverage is highest for black children (71 percent), followed by Hispanic and non-Hispanic white children children (63 percent), and Asian or Pacific Islander children (59 percent). (See Table 3) Government health insurance, which consists primarily of Medicaid but includes several other sources of coverage (see Definition section below), covered 30 percent of all children in 2006. (See Table 3) Differences by Region Children living in the Northeast and Midwest are more likely than children living in the South and the West to have health insurance coverage (93 percent for the Midwest and 92 percent for the Northeast versus 87 percent for the West and 85 percent for the South in 2006). (See Table 1) Children in Poverty, Immunization, AFDC/TANF, Food Stamp Receipt, Secure Parental Employment
State estimates of health insurance coverage for low income children (below 200 percent of poverty) are available at
2005-2006 state estimates of health care coverage by type of coverage are available at the Kaiser Family Foundation's State Health Facts Online at: State estimates for the consistency of health care coverage are available through the National Survey of Children's Health at http://nschdata.org/anonymous/Dataquery/DataQuery.aspx?control=5 (Select Health Care under State Profile) County level and state level estimates of health insurance coverage for the total population and children under age 18 are available from the U.S. Census Bureau for 2000 at http://www.census.gov/hhes/www/sahie International Estimates None available
National Goals
While there is no national goal specifically for health insurance coverage, there is a Healthy People 2010 goal to increase the percentage of children who have access to a specific source of ongoing care from 93 percent in 1998 to 97 percent by 2010.
More information available at:
http://www.health.gov/healthypeople/document/HTML/Volume1/01Access.htm#_Toc489432816 (See goal 1.4b)
These estimates reflect coverage for any portion of the year by private or public health insurance. Public health insurance consists primarily of Medicaid, but also includes Medicare, State Children's Health Insurance Programs (SCHIP), and Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).
1For a review of the literature, see Hadley, J. (2002). Sicker and Poorer: The Consequences of Being Uninsured. Chapter 6 - "Insurance, Medical Care Use, and Birth, Child, and Maternal Health Outcomes." Prepared for the Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org/uninsured/20020510-index.cfm/ (See Chapter 6, pp 53-71)
2 The Uninsured: Key Facts About Americans without Health Insurance. 7451-03(2007). Prepared for the Kaiser Commission on Medicaid and the Uninsured. Available at:http://www.kff.org/uninsured/upload/7451-03.pdf
3D. Cohen Ross and I.T. Hill, "Enrolling Eligible Children and Keeping Them Enrolled," The Future of Children 13 (Spring 2003). Available at: http://www.futureofchildren.org/usr_doc/tfoc13-1e.pdf
4D.C. Hughes and S. Ng, "Reducing Health Disparities Among Children," The Future of Children 13 (Spring 2003). Available at: http://www.futureofchildren.org/usr_doc/tfoc13-1j.pdf
5Holahan John, Lisa Dubay and Genevieve Kenney. (2003). Which children are still uninsured and why. The Future of Children: 13(1): 68-70.
6S. Pérez. "Growing Up American: Shaping New Policies for Latino Children and the Nation's Future." The Future of Children 14 (2), Summer 2004: 122-126. Available at: http://www.futureofchildren.org/usr_doc/gua.pdf
7Government insurance includes Medicaid, the State Children's Health Insurance Programs (SCHIP), and CHAMPUS/Tricare, the health insurance program for members of the armed services and their families.
Data Source
Data for 1987-1999: Trends in the Well-Being of America's Children and Youth 2001. U.S. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. Tables HC 1.1.A and HC 1.1.C
http://aspe.hhs.gov/hsp/01trends/contents.htm#HC (See Tables HC 1.1.A and HC 1.1.C)
Data for 2000: CPS Annual Demographic Survey, March Supplement
All other data for 2001: CPS Annual Demographic Survey, March Supplement
Data for 2002: Mills, Robert J. and Shailesh Bhandari. 2003. Health Insurance Coverage in the United States: 2002. Current Population Reports, P60-223. U.S. Census Bureau, Washington, DC.
CPS Annual Social and Economic Supplement, Tables HI03 and HI08
Data for poor children 2003: CPS Annual Social and Economic Supplement, Table HI03,
All other data for 2003: CPS Annual Social and Economic Supplement, Table HI08,
Data for poor children 2004: CPS Annual Social and Economic Supplement, Table HI03, http://pubdb3.census.gov/macro/032005/health/toc.htm All other data for 2004: CPS Annual Social and Economic Supplement, Table HI08, http://pubdb3.census.gov/macro/032005/health/toc.htm Data for poor children 2005: CPS Annual Social and Economic Supplement, Table HI03, http://pubdb3.census.gov/macro/032006/health/toc.htm All other data for 2005: CPS Annual Social and Economic Supplement, Table HI08, http://pubdb3.census.gov/macro/032006/health/toc.htm Data for poor children 2006: CPS Annual Social and Economic Supplement, Table HI03, http://pubdb3.census.gov/macro/032007/health/toc.htm All other data for 2006: CPS Annual Social and Economic Supplement, Table HI08, http://pubdb3.census.gov/macro/032007/health/toc.htm Raw Data Source
Bureau of Labor Statistics and U.S. Census Bureau, Current Population Survey, March Supplement Approximate Date of Next Update Fall 2008
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