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Health Care Costs and Financing

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Public health insurance coverage continues to play an important role for working families with children

A growing number of families with access to job-based insurance are relying on public coverage for at least some family members. In the past decade, the State Children's Health Insurance Program (SCHIP) and other public programs have provided a vital safety net for families, note two economists at the Agency for Healthcare Research and Quality (AHRQ). Jessica P. Vistnes, Ph.D., and Barbara S. Schone, Ph.D., analyzed data from the Medical Expenditure Panel Survey for 1997 and 2005, spanning the 8-year period following passage of SCHIP.

The authors speculate that the increased availability of public insurance and the high cost of purchasing job-based insurance for family coverage led to the trends of increased public coverage. For families without access to job-based insurance, roughly two-thirds of single-parent and over half of two-parent families with children had at least one family member covered by public insurance in 2005. Yet, even among families with access to job-based insurance, nearly half of minority single-parent families had at least one family member with public coverage.

For families with access to job-based insurance, the proportion of single- and two-parent families with children who were covered by only private insurance declined from 67 percent to 54 percent and from 85 to 80 percent, respectively. At the same time, the rate at which such families obtained full coverage either through public coverage alone or in combination with private coverage increased for both single- and two-parent families.

The rise in the mixture of public and private coverage for single-parent families mostly reflects a large increase in the rate at which adults elected private coverage and enrolled all of their children in public insurance. For example, the proportion of single-parent families in which adults had private coverage and the children were publicly insured tripled from 5.1 to 15.5 percent.

More details are in "Pathways to coverage: The changing roles of public and private sources," by Drs. Vistnes and Schone, in the January/February 2008 Health Affairs 27(1), pp. 44-57.

Reprints (AHRQ Publication No. 08-R033) are available from the AHRQ Publications Clearinghouse.

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