Key facts about health care coverage for children

  • The proportion of children who had health insurance coverage for any part of the year has increased over the past 15 years, from 89 percent in 2000 to 95 percent in 2016.
  • Children were more than twice as likely to be covered by government health insurance in 2016 as they were in 1987 (42 versus 19 percent, respectively).
  • The insurance coverage gap between Hispanic and non-Hispanic white children shrunk to 4 percentage points in 2016, from 17 percentage points in 1995.

Trends in children’s health care coverage

From 1990 to 1998, the proportion of children who were covered by any type of health insurance decreased from 87 to 85 percent. From 1998 to 2000, the proportion of children who were covered increased to 89 percent, and continued to rise slowly up through 2012. From 2012 to 2016, the proportion increased more rapidly, from 91 to 95 percent; however, because of a redesign of the relevant survey questions in 2013, the data are not strictly comparable. Nevertheless, data from other sources also show increases over that time period, from 93 to 95 percent.[1]

The proportion of children covered under private health insurance plans decreased from 1987 to 1995, from 74 to 66 percent, then increased to 71 percent by 2000. From 2000 to 2009, the share of children who were privately insured decreased again, from 71 to 61 percent. Since then, however, the rate has increased slightly, and was at 63 percent in 2016.

The proportion of children covered by public insurance rose fairly consistently from 1987 to 2015, from 19 to 43 percent of all children, but has decreased slightly since then, to 42 percent in 2016. Shifts in federal and state policy (including the introduction of the Children’s Health Insurance Program [CHIP]) led to major expansions in Medicaid coverage for children over the past 15 years. Today, the largest sources of public health insurance for children are Medicaid and CHIP, which are administered by the states (which have wide latitude in setting eligibility and benefits policies), although much funding comes from the federal government.[2]

Differences by race/Hispanic origin[3]

Hispanic children are less likely than other children to be covered by health insurance. In 2016, only 92 percent of Hispanic children had coverage for some part of the year, compared with 96 percent of non-Hispanic white children and 95 percent of black and Asian children. However, this gap has narrowed over time (Appendix 1).

The type of health coverage also varies greatly by race and Hispanic origin. Roughly three-quarters of non-Hispanic white and Asian children have private coverage (74 and 76 percent, respectively), compared with fewer than half of black and Hispanic children (49 and 45 percent, respectively).

There are several likely explanations as to why many Hispanic children are uninsured, including a lack of awareness of eligibility for public health insurance, ineligibility due to non-citizenship status, language barriers and other access difficulties, a reduced likelihood that parents work for employers who offer health insurance, and fears that using publicly funded insurance may lead to reprisals from immigration or other law enforcement officials.[4],[5],[6]

Differences by family type

Children in married-couple families, or in families headed by a single woman, are more likely to have health insurance coverage for at least some portion of the year than children in families headed by a single man. This gap has narrowed in recent years: In 2016, 95 percent of children in married-couple families had health insurance coverage, as did 94 percent of children in families headed by a single woman; this is compared with 92 percent of children in families headed by a single man (Appendix 1). However, children in families headed by a single man were more likely than those in families headed by a single woman to be covered by private health insurance; both were much less likely to be covered by private health insurance than children in married-couple families (54, 42, and 72 percent, respectively) (Appendix 2).

Differences by income

The likelihood of being covered by health insurance for at least part of the year increases with income. In 2016, 96 percent of children living in families with incomes of $75,000 or more had coverage. In contrast, only 93 percent of children in families with incomes under $50,000 were covered. As family income goes up, the likelihood of coverage by public insurance goes down, and the likelihood of coverage by private insurance goes up. However, 20 percent of children in families with incomes over $75,000 per year still had public insurance in 2016.

In the past 16 years, the rate of insurance coverage has increased most among children in families making less than $25,000 per year, from 81 to 93 percent. For children in families making between $25,000 and $49,999 per year, the rate of insurance coverage has been increasing since 2007, going from 84 to 93 percent. For children in families with higher incomes, coverage rates were similar in 2000 and 2016, after a decline between 2006 and 2007 (Appendix 1).

Rates of coverage under private insurance have fallen for children at all family income levels in the past decade, but declines have been greater for children in lower- and middle-income families. For instance, the proportion of children in families making $25,000 to $49,999 per year who were covered by private insurance declined more than a third from 2000 to 2016 (from 70 to 43 percent); for children in families that made more than $75,000, the proportion of children with private insurance was only slightly lower in 2016 than in 2000 (86 and 94 percent, respectively) (Appendix 2).

Differences by type of health insurance and poverty status

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—most often Medicaid, a means-tested program.

Although Medicaid (as of 2016) covers 39 percent of children overall, it covers 77 percent of children in poverty. Among children in poverty, Medicaid coverage is highest for black and Hispanic children (80 percent), followed by non-Hispanic white children (72 percent) and Asian children (67 percent). Younger children are more likely to be covered by Medicaid; in 2016, 80 percent of children in poverty ages 0 to 5, 78 percent ages 6 to 11, and 73 percent ages 12 to 17 were covered by Medicaid (Appendix 3).

Government health insurance, which consists primarily of Medicaid but also includes several other sources of coverage (see Definition section below), covered 42 percent of all children in 2016 (Appendix 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 at least part of the year (97 and 96 percent, respectively, for the Northeast and Midwest, versus 94 percent for both the West and South, in 2016) (Appendix 1). There is wide variation across states in rates of uninsured children, with children in Alaska roughly 10 times more likely than children in Massachusetts to be without health insurance in 2016.[7]

Differences for children and youth with special health care needs

Children and youth with special health care needs, and their families, face additional challenges in navigating complex health care systems. Although children and youth with special health care needs are more likely to be insured, compared to the general population of children and youth, nearly 4 percent did not have health insurance in 2016. Similar to all children and youth, this group has seen a shift toward public insurance coverage and away from private insurance over the last 15 years. In 2001, nearly three-quarters of children and youth with special health care needs had private insurance (73 percent) and fewer than one-third had public insurance (30 percent). However, in 2016, the proportion of children and youth with special health care needs who had either private or public insurance was split fairly evenly (54 and 48 percent, respectively).

State and local estimates

State estimates of health insurance coverage for children (under age 18) and coverage for low-income children (under age 19, below 200 percent of the federal poverty level) are available from the Census Bureau (tables HI05 and HI10): https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.html.

2016 state estimates of children’s health care coverage, by coverage type, are available at the Kaiser Family Foundation’s State Health Facts Online at http://kff.org/other/state-indicator/children-0-18/.

2016 state estimates for the continuity of children’s health care coverage (continuous coverage for the past 12 months) are available through the National Survey of Children’s Health at the Data Resource Center for Child & Adolescent Health.

County- 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 2008–2016 at https://www.census.gov/programs-surveys/sahie.html.

Data and appendices

Data source

Data for 2015–2016: U.S. Census Bureau. (2016–2017). CPS Table Creator [Data tool]. Retrieved from http://www.census.gov/cps/data/cpstablecreator.html.

Data for 1999–2014: U.S. Census Bureau. (2000–2015). CPS ASEC health insurance historical tables [Table HIB/HIC-3]. Retrieved from https://www.census.gov/topics/health/health-insurance/data/tables.2017.html.

Data for 1987–1998: U.S. Department of Health & Human Services, Office of The Assistant Secretary for Planning and Evaluation. (2000). Trends in the well-being of America’s children and youth, 2000 [Tables HC 3.1.A & HC 3.1.C]. Retrieved from https://aspe.hhs.gov/report/trends-well-being-americas-children-and-youth-2000.

Children and youth with special health care needs data for 2016: Child Trends’ original analyses of data using U.S. Department of Health and Human Services, Maternal and Child Health Bureau. (2017). 2016 National Survey of Children’s Health [Dataset]. Retrieved from https://www.census.gov/programs-surveys/nsch.html.

Children and youth with special health care needs data for 2001–2010: Child Trends’ original analyses of data using U.S. Department of Health and Human Services, National Center for Health Statistics. (2002–2011). National Survey of Children with Special Health Care Needs, 2001, 2005–2006, and 2009–2010 [Dataset]. Retrieved from https://www.cdc.gov/nchs/slaits/cshcn.htm.

Raw data source

Bureau of Labor Statistics & U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement: http://www.census.gov/cps/

National Survey of Children with Special Health Care Needs: http://www.cdc.gov/nchs/slaits/cshcn.htm

National Survey of Children’s Health: https://www.census.gov/programs-surveys/nsch.html

Appendices

Appendix 1

Appendix 2

Appendix 3

Appendix 4

Background

Definition

These estimates reflect coverage for any portion of the year by private or public health insurance, except for estimates for children and youth with special health care needs, which reflect coverage at the time of the survey. Public health insurance consists primarily of Medicaid, but also includes Medicare, State Children’s Health Insurance Programs (SCHIP/CHIP), and the Medical Care Program of the Uniformed Services (CHAMPUS/Tricare).

In 2013, there was a redesign in the way questions about health insurance were asked. These changes were meant to enhance reporting for earlier time periods, along information about other people in the household and the type of coverage. More details on the changes and their effects are available at https://www.census.gov/srd/papers/pdf/RSM2014-02.pdf.

Endnotes

[1] Cohen, R. A., Martinez, M. E., & Zammitti, E. P. (2017). Op cit.

[2] U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. (2018). Financing. Woodlawn, MD: Author. Retrieved from https://www.medicaid.gov/chip/financing/index.html.

[3] Beginning in 2002, the Census allowed respondents to select more than one racial category. The white, black and Asian categories refer to those who selected only one race. Hispanic children may be of any race, while white children in this report do not include Hispanic youth.

[4] Flores, G., Lin, H., Walker, C., Lee, M., Portillo, A., Henry, M., Fierro, M., & Massey, K. (2016). A cross-sectional study of parental awareness of and reasons for lack of health insurance among minority children, and the impact on health, access to care, and unmet needs. International Journal for Equity in Health, 15(44). Retrieved from http://equityhealthj.biomedcentral.com/articles/10.1186/s12939-016-0331-y;.

[5] Holahan, J., Dubay, L., & Kenney, G. M. (2003). Which children are still uninsured and why. Future of Children, 13(1), 54-79. Retrieved from https://www.jstor.org/stable/1602639?seq=1#page_scan_tab_contents.

[6] Pérez, S. M. (2004). Shaping new possibilities for Latino children and the nation’s future. Future of Children, 14(2), 122-126. Retrieved from http://www.jstor.org/stable/10.2307/1602798.

[7] U.S. Census Bureau. (2017). American Community Survey tables for health insurance coverage [Table HI- 05]. Washington, DC: Author. Retrieved from https://www.census.gov/data/tables/time-series/demo/health-insurance/acs-hi.html.