Children's health insurance coverage varies widely, study suggests

Even states with relatively low rates of uninsured children have gaps in coverage for some groups of children, according to researchers. Conversely, some states demonstrating high rates of uninsurance have relatively low gaps or disparity between children when grouped by age, race/ethnicity and income groups.

"Although progress has been made toward reducing rates of uninsured children across the United States, there are still significant variations at both the state and national levels in children's health insurance coverage -- variations we see by age, race/ethnicity and income." said Lynn Blewett, Ph.D., principal investigator of the study and principal investigator of the SPH-based, Robert Wood Johnson Foundation-funded State Health Access Data Assistance Center (SHADAC).

The impact of uninsurance can be devastating. Differences in insurance status are also associated with marked differences in access to health care, resulting in delays in necessary care in uninsured populations. Often, by the time such patients get care their sickness has already progressed to a more advanced stage. When this happens, the costs of care go up.

"Our research has found that there are still disparities -- sometimes broad disparities -- in health insurance coverage for older, low-income and minority children when compared to their peers," said Julie Sonier, M.P.A., lead author of the study and deputy director of SHADAC.

Across the Nation

Overall, Nevada had the highest uninsurance rate for children (21 percent) and Massachusetts had the lowest (two percent) in 2008.

When examining rates of uninsured children within states by race/ethnicity, researchers found that Rhode Island, Minnesota and Pennsylvania have relatively low uninsurance rates for children but have large gaps in insurance coverage by race/ethnicity. In contrast, states like Texas, Arizona, Florida and Nevada all have high rates of uninsured children, but have relatively low coverage gaps by race/ethnicity.

Assessing uninsurance rates by family income, researchers found that, for the U.S. as a whole, children at or below 138 percent of the poverty level are 2.7 times more likely to be uninsured than children in families with income at or above 200 percent of poverty. Although states such as Massachusetts, Wisconsin and Iowa have among the lowest rates of uninsurance for children, they have sizable gaps by income group.

In terms of gaps across age groups, children ages 12 to 17 are 35 percent more likely to be uninsured than the youngest children. Maine has a lower-than-average uninsurance rate for children (5.9 percent), but has among the largest gaps in coverage across age groups. Nevada, on the other hand, has the highest uninsurance rate and shows little variation across age groups.

"Although we've made progress in recent years toward reducing uninsurance for children, this new analysis shows that some groups of children fare better than others, and that there is significant room for improvement even in states that have low uninsurance rates for children," said Sonier.

Results in Minnesota

Analyzing data from the 2008 American Community Survey (ACS), an annual survey conducted by the U.S. Census Bureau, researchers found that despite Minnesota's relatively low uninsurance rate (6.2 percent), some groups of children are much more likely to be uninsured than others.

Hispanic children, for example, are 5 times more likely than white children to be uninsured in Minnesota. Although there is a sizeable gap in insurance coverage for Hispanic children compared to white children nationally, the size of this gap in Minnesota is nearly double what it is nationally.

"In addition, Minnesota children from low-income families are more than three times as likely to be uninsured than their peers from higher-income families. This income-related gap is larger than national averages. Because most of these uninsured low-income Minnesota children are likely eligible for public insurance coverage, it appears that this gap is less related to eligibility for coverage than it is to other factors, such as awareness of eligibility or the administrative burden of enrolling."

According to new 2009 estimates released in September by the Census Bureau, Minnesota was one of only two states nationally that experienced a significant increase in the rate of uninsurance among children.

"Minnesota has historically enjoyed a low rate of uninsurance compared to other states, but for some groups of children we don't do nearly as well," said Sonier. "We need to pay attention to these gaps and monitor progress in reducing them over time."