The Rate of Children Without Health Insurance Is Rising, Particularly among Latino Children of Immigrant Parents and White Children
Health insurance is critical to children’s well-being. Children who have health insurance are more likely than those without coverage to use preventative health services,1,2,3 experience fewer emergency room visits and hospitalizations,4 have better overall health,5,6,7 and have better educational and labor force outcomes.8,9 Over the last decade, increased federal and state funding of the Child Health Insurance Program (CHIP)10 and the implementation of the Affordable Care and Patient Protection Act (or ACA)11,12 helped improve health insurance coverage among children.10 Now, though, for the first time in close to a decade, the percentage of children under age 19 who did not have health insurance has increased, rising from 5.0 percent in 2017 to 5.5 percent in 2018, according to a recent Census report.13 This amounts to roughly 425,000 more children who were uninsured in 2018 than in 2017.
Historically, rates of children without health insurance in the United States have varied across racial/ethnic groups, with Hispanic and non-Hispanic Black children more likely to be uninsured than their non-Hispanic White counterparts.13,14,15,16 Children’s access to services— including health insurance and health care—is shaped by the immigrant experiences of their parents.a,17 For example, prior research has found that having even just one U.S.-born parent is associated with a greater likelihood of having a regular health care provider18 and better child health outcomes.19
In this brief, we examine whether the recent increase in the health uninsured rate has been experienced similarly by children across racial/ethnic groups. We used data from the 2011-2019 Current Population Survey (CPS), covering the time period from 2010 to 2018, to examine patterns of uninsured rates over time for children from the three largest racial/ethnic groups: Hispanic, non-Hispanic White, and non-Hispanic Black children.b We also compared the uninsured rates of Hispanic children with at least one U.S.-born parent with those of Hispanic children with only foreign-born parents (including foreign-born single parents). Methods of data collection and processing for the CPS have changed over time. Therefore, while we report overall trends in uninsured rates from 2010 to 2018, we were only able to statistically compare changes in children’s uninsured rates within the three time periods for which direct comparisons can be made: 2010-2012, 2013-2015, and 2016-2018.c For clarity, we explicitly note in the text where direct comparisons can or cannot be made.
Endnotes and References
a We used data from 2011-2019 to look at health insurance coverage for children ages 1 to 18 at the time of the survey. Data on health insurance coverage are collected for the previous year. For example, data collected in 2018 gather information about health insurance coverage in 2017. Likewise, for children who were either 1 or 18 years old at the time of the survey, data were collected on health insurance coverage for the previous year (when they were aged 0 and 17, respectively).
b Another common data source of health insurance coverage in the United States is the American Community Survey (ACS). The Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC), however, has produced national estimates of health insurance coverage since 1987 and includes more detailed questions on health insurance coverage than ACS (U.S. Census Bureau, 2019); see also Pascale J, Boudreaux M, King R. (2016). For state-level estimates, ACS is the preferred data source (U.S. Census Bureau, 2019)
c We drew on nationally representative data from the Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) from 2011 to 2019. To address underreporting of health insurance coverage, the Census Bureau administered, in 2014, a redesign of health insurance questions in the CPS ASEC. For ASEC 2011-2016 and ASEC 2019, we used Public Use Microdata Files from the Census Bureau FTP site; for ASEC 2017 and 2018, we used the 2017 ASEC Research File and 2018 Bridge File to draw upon health insurance data that can be directly compared with those of ASEC 2019. For information on changes in the methods of data collection and processing, see Appendix A of Health Insurance Coverage in the United States: 2018. Several studies have also compared estimates of health coverage before and after the redesign.
1 Wagnerman, K. (2017). Medicaid Provides Needed Access to Care for Children and Families. Washington, DC: Center for Children and Families, Health Policy Institute, Georgetown University. Retrieved from https://ccf.georgetown.edu/wp-content/uploads/2017/03/Medicaid-provides-needed-access-to-care.pdf
2 Moreno-Serra, R., & Smith, P.C. (2012). Does progress towards universal health coverage improve population health? The Lancet, 380(9845), 917-923. Doi: https://doi.org/10.1016/S0140-6736(12)61039-3
3 Baicker, K., Taubman, S. L., Allen, H.L., Bernstein, M., Gruber, J.H., Newhouse, J.N., Schneider, E.C., Wright, B.J., Zaslavsky, A.M., & Finkelstein, A.N. (2013). The Oregon Experiment — Effects of Medicaid on Clinical Outcomes. New England Journal of Medicine, 368, 1713-1722. Doi: 10.1056/NEJMsa1212321
4 Hendren, N., & Sprung-Keyser, B.D. (2020). A Unified Welfare Analysis of Government Policies. Quarterly Journal of Economics. Doi: https://doi.org/10.1093/qje/qjaa006
5 Murphey, D. (2017). Health Insurance Coverage Improves Child WellBeing. Bethesda, MD: Child Trends. Retrieved from https://www.childtrends.org/publications/health-insurance-coverage-improves-child-well
6 Hendren, N., & Sprung-Keyser, B.D. (2020). A Unified Welfare Analysis of Government Policies. Quarterly Journal of Economics. Doi: https://doi.org/10.1093/qje/qjaa006
7 Boudreaux, M. H., Golberstein, E., & McAlpine, D. D. (2016). The long-term impacts of Medicaid exposure in early childhood: Evidence from the program’s origin. Journal of Health Economics, (45) 161-175. https://doi.org/10.1016/j.jhealeco.2015.11.001
8 Cohodes, S.R., Grossman, D.S., Kleiner, S.A., & Lovenheim, M.F. (2015). The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions. Journal of Human Resources, 51(3), 727-759. Doi: 10.3368/jhr.51.3.1014-6688R1
9 Brown, D. W., Kowalski, A. E., & Lurie, I. Z. (2015). Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts? Cambridge, MA: National Bureau of Economic Research. Retrieved from https://www.nber.org/papers/w20835
10 Kenney, G. M., Haley, J., Pan, C., Lynch, V., & Buettgens, M. (2016). Children’s Coverage Climb Continues: Uninsurance and Medicaid/CHIP Eligibility and Participation Under the ACA. Washington, DC: Urban Institute and the Robert Wood Johnson Foundation. Retrieved from https://www.urban.org/research/publication/childrens-coverage-climb-continues-uninsurance-and-medicaidchip-eligibility-andparticipation-under-aca
11 Garrett, B. & Gangopadhyaya, A. (2016). Who Gained Health Insurance Coverage Under the ACA; and Where Do They Live? Washington, DC: Urban Institute. Retrieved from https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2896220#
12 Alker, J., & Chester, A. (2015). Children’s Health Insurance Rates in 2014: ACA Results in Significant Improvements. Washington, DC: Center for Children and Families, Health Policy Institute, Georgetown University. Retrieved from https://ccf.georgetown.edu/wp-content/uploads/2015/10/ACS-report-2015.pdf
13 Berchick, E.R., Barnett, J.C., & Upton, R.D. (2019). Health Insurance Coverage in the United States: 2018. Suitland-Silver Hill, MD: United States Census Bureau. Report No. P60-267. Retrieved from https://www.census.gov/library/publications/2019/demo/p60-267.html
14 Berdahl, T.A., Friedman, B.S., McCormick, M.C., & Simpson, L. (2013). Annual Report on Health Care for Children and Youth in the United States: Trends in Racial/Ethnic, Income, and Insurance Disparities Over Time, 2002–2009. Academic Pediatrics, 13(3), 191-203. Doi: https://doi.org/10.1016/j.acap.2013.02.003
15 Bethell, C.D., Kogan, M.D., Strickland, B.B., Schor, E.L., Robertson, J., & Newacheck, P.W. (2011). A National and State Profile of Leading Health Problems and Health Care Quality for U.S. Children: Key Insurance Disparities and Across-State Variations. Academic Pediatrics, 11(3), S22-S33. Doi: https://doi.org/10.1016/j.acap.2010.08.011
16 Larson, K., Cull, W.L., Racine, A.D., & Olson, L.M. (2016). Trends in Access to Health Care Services for U.S. Children: 2000–2014. Pediatrics, 138(6), e20162176. Doi: https://doi.org/10.1542/peds.2016-2176
17 Rojas-Flores, L. (2017). Latino US-Citizen Children of Immigrants: A Generation at High Risk. Summary of Selected Young Scholars Program Research. New York, NY: Foundation for Child Development. Retrieved from https://www.fcd-us.org/latino-us-citizen-children-immigrants-generation-high-risk/
18 Weathers, A. C., Novak, S. P., Sastry, N., & Norton, E. C. (2008). Parental nativity is an important factor associated with where children usually go for health care. Maternal and Child Health Journal, 12(4), 499–508. https://doi.org/10.1007/s10995-007-0278-0
19 Weathers, A. C., Novak, S. P., Sastry, N., & Norton, E. C. (2008). Parental nativity affects children’s health and access to care. Journal of Immigrant and Minority Health, 10(2), 155-165. https://doi.org/10.1007/s10903-007-9061-y