Fewer children in working families are uninsured, but many still falling through the cracks

Recent strides have been made to increase health care coverage for low income children in California, but a significant number of children in working poor families remain uninsured, according to a new study by researchers at the University of California, Berkeley.

The study found that these children were far more likely to be uninsured and less likely to have a usual source of health care than were children from nonworking poor and nonpoor families. In addition, a larger proportion of children older than age 2 from working poor families either had never seen a dentist or had not received dental care in the previous two years of the survey.

"This survey highlights the health access disparities that still exist in California," said lead author Sylvia Guendelman, professor of health policy and management at UC Berkeley's School of Public Health. "These are kids that are falling through the cracks in health coverage. They are from families whose incomes are too high to qualify for Medi-Cal, yet too low to afford their own health insurance and who do not have employer-sponsored health care."

The working poor are defined as households of four earning less than 200 percent of the federal poverty level, or $35,300 per year, and who did not rely upon Temporary Assistance for Needy Families (TANF) or Welfare to Work aid as their primary sources of income. According to the 2001 federal poverty guidelines used by the researchers, the annual income level for a family of four at the poverty level is $17,650.

Although the study found that health access disparities still exist, it also found reason to be optimistic. The study showed that fewer kids from working poor families are uninsured since California implemented the Healthy Families program in 1998, a state-supported, low-cost insurance plan for children and teens who do not have other insurance or who qualify for Medi-Cal. According to state figures from 1994, as many as 32 percent of children from working poor families were without health insurance compared with 20 percent in the current study.

"Our results are showing that there has been quite a bit of improvement since Healthy Families began," said Guendelman. "But as health care costs go up, and the California budget is decreasing, we're seeing a lot of talk about either halting new enrollment or somehow pulling back on the program. That would be a tremendous setback to a program that has proven beneficial to tens of thousands of children across the state. We should be protecting that program instead of making it vulnerable to cutbacks."

The authors of the study, published in the January 2005 issue of the monthly journal Medical Care, analyzed data from the 2001 California Health Interview Survey. Information from 16,528 children ages 17 and younger who had corresponding information on parental work status and income were included in the analysis.

Children from working poor families were compared with those from nonworking poor families earning less than 200 percent of the federal poverty level, or $35,300 for a family of four, who also relied upon TANF as the primary source of income. The nonpoor group included families earning at least 200 percent of the federal poverty level, and who did not receive TANF benefits.

The study found that 20.4 percent of children in working poor families were uninsured compared with 7.9 percent from poor and 3.8 percent from nonpoor families. In addition, 10.9 percent of children in working poor families did not have a usual source of healthcare, such as a regular doctor or community clinic, compared with 3.9 percent of children in nonworking poor families.

The researchers found that children in working poor families were more likely to be Latino, undocumented and to reside in rural areas. The researchers noted that families in California are particularly vulnerable to being uninsured because of the state's high cost of living.

"The consequences of curtailing efforts to insure all children in California are significant," said Guendelman. "Without insurance, children are less likely to receive preventive care and more likely to delay health care until problems become more acute."

Other authors of the study are Veronica Angulo, a former UC Berkeley graduate student in public health, and Doug Oman, UC Berkeley adjunct assistant professor of maternal and child health.

Funding from the state Department of Health and Human Services Agency for Healthcare Research and Quality, UC Berkeley Center for Latino Policy Research and the UC Berkeley Center for Child and Youth Policy helped support this study.