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Health Care Costs and Financing

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As parents gain a job with private health insurance coverage, their children may lose public coverage

More than 9 million U.S. children have no health insurance coverage, despite expansions in State Medicaid insurance and the State Children's Health Insurance Program (SCHIP). An Oregon study found a higher rate of uninsured children among privately insured parents than parents covered by public insurance. This suggests that when parents succeed in pulling themselves out of poverty and gaining employment with private health insurance coverage, their children may lose public insurance, notes Jennifer E. DeVoe, M.D., Ph.D.

Dr. DeVoe and colleagues at Oregon Health and Science University studied families enrolled in Oregon's food stamp program, which has eligibility requirements similar to Oregon's Medicaid program. They examined the link between parental insurance status and type and children's insurance status. Nearly 11 percent of children, presumed eligible for public insurance, were nonetheless uninsured. Children more likely to be uninsured were those who had an employed parent, were Hispanic, or came from families with higher household earnings (from $26,616 to $36,996 per year, 133 to 185 percent of the Federal poverty level).

Children with an uninsured parent were 12 times more likely to be uninsured that children with insured parents. Yet children of privately insured parents were more than four times more likely to be uninsured than children whose parents were covered by public insurance such as Medicaid. Thus, low-income Oregon parents at the higher end of the public insurance income threshold and those with private insurance were having the most difficulty keeping their children insured.

This finding contrasts with previous reports that employees with single coverage, who decline employer-sponsored family coverage, enroll their children in public programs. Privately-covered parents with uninsured children may not be able to afford the premiums for family coverage, or employers may not offer coverage to children who qualify for public coverage. On the other hand, parents may think that their children are not eligible for Medicaid or SCHIP once adults are no longer covered, which is often not the case. The study was supported in part by the Agency for Healthcare Research and Quality (HS14645 and HS16181).

More details are in "Uninsured but eligible children: Are their parents insured? Recent findings from Oregon," by Dr. DeVoe, Lisa Krois, M.P.H., Christine Edlund, M.Sc., and others in the January 2008 Medical Care 46(1), pp. 3-8.

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