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Children's Health Insurance Coverage Is Related to Family Structure and Income

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Press Release Date: March 3, 1999

Between 1977 and 1996, the percentage of children who were uninsured increased substantially, but the increase occurred almost exclusively among children living with only one parent. In addition, the percentage of children in single-parent families with private health insurance increased over this period. However, they were still much less likely to have private insurance and more likely to be uninsured than children in two-parent households. These are the findings of a new study, published in the March 1999 issue of Medical Care Research and Review, that examined health insurance trends, specifically focusing on the relationship between children's family structure and their health insurance coverage.

"This study shows that information on family structure can provide an additional gauge for determining which children are at increased risk of lacking health insurance," said Lisa A. Simpson, M.B., B.Ch., M.P.H., deputy administrator for the Agency for Health Care Policy and Research (AHCPR). "This knowledge can help in developing public policies that are targeted to reduce these gaps and improve the quality of health care services."

Today's findings pre-date implementation of the State Children's Health Insurance Program (SCHIP), an effort initially proposed by President Clinton and launched in 1997 to provide coverage to more uninsured children. Working through states, SCHIP is aimed especially at providing coverage to children in families with incomes too high to qualify for Medicaid. With $24 billion set aside over five years, SCHIP is the largest single expansion of health insurance coverage for children in more than 30 years.

The authors, Robin M. Weinick, Ph.D., and Alan C. Monheit, Ph.D., researchers at AHCPR, analyzed data from three nationally representative medical expenditure surveys conducted by AHCPR in 1977, 1987, and 1996. They found that family structure plays an important role in predicting children's health insurance coverage. For example, having two employed parents living in the same household greatly increased the chances of children having private insurance. These children also were less likely to be uninsured than those living in two-parent households with only one working parent or those living in single-parent households.

Other findings include:

  • Over this period, the percentage of children covered by private insurance declined, and the percentage of children with public coverage increased.
  • In 1996, over 20 percent of privately insured children whose single parent previously had been married received their coverage from a policyholder who did not live with them, most likely the children's other parent. This compares with a 1987 rate of only 5 percent.
  • Children whose single parents never married were far more likely to be publicly insured in 1987 and 1996 than those whose parents had been married at some point (65.4 percent versus 29.4 percent in 1987; 62.9 percent versus 30.3 percent in 1996).
  • The percentage of children in two-parent families with public coverage doubled between 1987 and 1996, from 6.1 percent to 12.7 percent. This increase was primarily among poor families and those with only one working parent, and was consistent with the expansions in the Medicaid program during this period.

Details are in "Children's Health Insurance Coverage and Family Structure, 1977-1996," published in Medical Care Research and Review, Vol. 56, No. 1 (March 1999), pp. 55-73.

Select for more information on AHCPR medical expenditure data.

For additional information contact AHCPR Public Affairs: Karen Carp, (301) 427-1858 (, Karen Migdail, (301) 427-1855 (

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