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Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021

IMPORTANCE: Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. OBJECTIVE: To compare overall rates, COVID-19 PHE-related changes, and child and family char...

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Autores principales: Daw, Jamie R., Yekta, Sarra, Jacobson-Davies, Faelan E., Patrick, Stephen W., Admon, Lindsay K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10665966/
https://www.ncbi.nlm.nih.gov/pubmed/37991782
http://dx.doi.org/10.1001/jamahealthforum.2023.4179
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author Daw, Jamie R.
Yekta, Sarra
Jacobson-Davies, Faelan E.
Patrick, Stephen W.
Admon, Lindsay K.
author_facet Daw, Jamie R.
Yekta, Sarra
Jacobson-Davies, Faelan E.
Patrick, Stephen W.
Admon, Lindsay K.
author_sort Daw, Jamie R.
collection PubMed
description IMPORTANCE: Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. OBJECTIVE: To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. DESIGN, SETTINGS, AND PARTICIPANTS: This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children’s Health of children from age 0 to 17 years living in noninstitutional settings. EXPOSURE: Parent- or caregiver-reported current child health insurance type defined as public or commercial. MAIN OUTCOMES AND MEASURES: Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child’s needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child’s health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. RESULTS: Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, −20.8 pp; 95% CI, −21.6 to −20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children’s health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children.
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spelling pubmed-106659662023-11-22 Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021 Daw, Jamie R. Yekta, Sarra Jacobson-Davies, Faelan E. Patrick, Stephen W. Admon, Lindsay K. JAMA Health Forum Original Investigation IMPORTANCE: Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. OBJECTIVE: To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. DESIGN, SETTINGS, AND PARTICIPANTS: This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children’s Health of children from age 0 to 17 years living in noninstitutional settings. EXPOSURE: Parent- or caregiver-reported current child health insurance type defined as public or commercial. MAIN OUTCOMES AND MEASURES: Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child’s needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child’s health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. RESULTS: Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, −20.8 pp; 95% CI, −21.6 to −20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. CONCLUSIONS AND RELEVANCE: The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children’s health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children. American Medical Association 2023-11-22 /pmc/articles/PMC10665966/ /pubmed/37991782 http://dx.doi.org/10.1001/jamahealthforum.2023.4179 Text en Copyright 2023 Daw JR et al. JAMA Health Forum. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Daw, Jamie R.
Yekta, Sarra
Jacobson-Davies, Faelan E.
Patrick, Stephen W.
Admon, Lindsay K.
Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021
title Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021
title_full Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021
title_fullStr Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021
title_full_unstemmed Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021
title_short Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021
title_sort consistency and adequacy of public and commercial health insurance for us children, 2016 to 2021
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10665966/
https://www.ncbi.nlm.nih.gov/pubmed/37991782
http://dx.doi.org/10.1001/jamahealthforum.2023.4179
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