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  • Publication # 13-RA012

The proportion of middle-income families with health insurance coverage declined from 2003 to 2008

Health Care Costs and Financing

The percentage of middle-income U.S. families with full-year health insurance coverage declined significantly from 2003 to 2008, revealed a new study. Researchers analyzed data from AHRQ’s Medical Expenditure Panel Survey-Household Component for 2003 and 2008. A total of 18,581 children, aged 0 to 17 years, were studied; all were linked to 1 or both parents. Various demographic variables were obtained, including the child’s age and race, parent employment and education, and monthly health insurance coverage status. 

Insurance coverage changes were most notable among middle-income families, with non-significant change for low-income and little change for high-income families. For example, middle-income children and their parent(s) insured for the full year decreased from 78.8 percent to 72.8 percent.

When assessed cross-sectionally, the percentage of uninsured middle-income families rose significantly from 5.6 percent to 8.3 percent, and those with private insurance decreased from 75.7 percent to 70.2 percent. Even with the Affordable Care Act and the availability of health insurance exchanges, current estimates predict that a small percentage of the U.S. population may remain uninsured. 

To correct this problem, the authors suggest that private health insurance coverage must become more affordable and public coverage must become more widely available. The study was supported in part by AHRQ (HS16181).

See "Changes in health insurance for US children and their parents: Comparing 2003 to 2008," by Heather Angier, M.P.H., Jennifer E. DeVoe, M.D., D.Phil., and others in the January 2013 Family Medicine 45(1), pp. 26-32.


Page last reviewed September 2013
Internet Citation: The proportion of middle-income families with health insurance coverage declined from 2003 to 2008: Health Care Costs and Financing. September 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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