2 million children with insured parents are uninsured in the U.S.

Some 2.3 million children a year, mostly from low- to middle-income families, have no health care coverage to pay for preventive or other medical needs, even though at least one of their parents is insured, according to a new study supported by HHS' Agency for Healthcare Research and Quality and the National Center for Research Resources, part of HHS' National Institutes of Health.

The new study, published in the Oct. 22/29, 2008, online issue of JAMA, is one of the first to examine the characteristics of uninsured children under age 19 whose parents were insured all year. These children account for a quarter of the estimated 9 million uninsured children in the United States.

Researchers led by Jennifer DeVoe, M.D., of the Oregon Health & Science University in Portland, studied 2002-2005 national data from AHRQ's Medical Expenditure Panel Survey and found that children from low-income families where at least one parent had health insurance were more than twice as likely to be uninsured at some point during the year as were similar children from high-income families. They were also 73 percent more likely to be uninsured for more than 6 months. In 2005, a typical, low-income family of four earned between roughly $24,000 and $39,000, whereas the typical high-income family of four earned more than $77,000 a year.

Children from middle-income families - those earning between $39,000 and $77,000 a year for a typical four-member family - had a 48 percent greater chance of being uninsured with at least one insured parent at some point during the year compared with high-income children and had a 56 percent higher likelihood of being uninsured for over 6 months.

"These findings add to our understanding of children's health care coverage gaps," said AHRQ Director Carolyn M. Clancy, M.D. "When children are insured, they have improved access to a regular source of care, including preventive health services." Dr. Clancy added that some of the low-income uninsured children likely qualify for public coverage, but their parents may not be aware of their eligibility.

The researchers also found that:

• Children living with an insured single parent had two times the odds of being uninsured at any point during the year as children living with two married people of whom at least one was insured and more than twice the odds of having a coverage gap lasting 6 months or more.
• Children with at least one parent who did not complete high school were 44 percent more likely than children whose parent or parents were high school graduates to be uninsured at any point during the year, and they had 87 percent greater odds of being uninsured for more than 6 months.
• Hispanic children had a 65 percent higher probability than non-Hispanic, white children of being uninsured at some point during the year with an insured parent and an 80 percent greater chance of being uninsured for more than 6 months.
• Children whose parents had Medicaid or other public insurance were 54 percent less likely to be uninsured at any point during the year than children with privately insured parents and 59 percent less likely to be uninsured for more than 6 months.
• Children living in the South and those in the West had 70 percent and 52 percent greater odds, respectively, of being uninsured at some point during a year with a parent covered all year, compared to children living in the Northeast. They also had an 83 percent and 49 percent greater likelihood, respectively, of being uninsured for more than 6 months.

The study was supported in part by the Biostatistics Shared Resource of the Oregon Health & Science University and the Oregon Clinical Translational Research Institute, which is part of a national Clinical and Translational Science Award consortium funded through the National Center for Research Resources of the National Institutes of Health.