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Number of underinsured children increases by 2.4 million


High out-of-pockets costs of inadequate insurance the main driver

A study led by University of Pittsburgh School of Medicine researchers found that the number of underinsured children increased by 2.4 million from 2016 to 2019.

The researchers found that underinsurance of children was driven by increased rates of inadequate insurance rather than a rise in the uninsured or inconsistent insurance coverage. Families who have children with special health care needs and private insurance were hit particularly hard.

The study analyzed data from the the National Survey of Children’s Health, an annual survey about the physical and mental health of newborns through 17-year-olds. Underinsured was defined as those lacking adequate insurance, meaning it allowed children to see providers and protected against unreasonable out-of-pocket expenses. High out-of-pocket costs was a main driver in rising insurance inadequacy, and these high fees may force families to delay or forgo care for their child.

The researchers suggest that insurers are increasingly transferring costs to individuals and families through higher copays and premiums and, increasingly, through high-deductible plans. This may explain why children with private health insurance were more likely to be underinsured than those on public plans, such as Medicaid or Children’s Health Insurance Program.

The study also found an increase in the rate of underinsurance in white children from middle-income, highly educated families. In addition, kids with more complex special health care needs were more likely to be underinsured than those with less complex or no special health needs.

The researchers state that to tackle the problem of child underinsurance, large-scale policy reforms such as broadening eligibility for Medicaid or creating a universal health insurance program for all U.S. kids may be required. Smaller policy changes—such as making it easier to apply for and stay on Medicaid or cash assistance programs to help cover out-of-pocket expenses—also would be beneficial.

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