Hanson KL; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.

Presented by: Karla L. Hanson, Ph.D., Assistant Professor, Health Services Management and Policy Program, Robert J. Milano Graduate School of Management and Urban Policy, New School University, 66 Fifth Avenue, 9th floor, New York, NY 10011. Tel: 212-229-5383; Fax: 212-229-5335; E-mail: hansonk@newschool.edu.

Research Objective: While the number of uninsured Americans continues to grow, the composition of family insurance arrangements is also changing. Industry shifts and policy initiatives have created complex family insurance patterns, with children increasingly likely to have insurance status that is different from that of their parents. This added complexity is important for two reasons. First, children are more likely to enroll in benefits for which they are eligible when all family members are eligible. Second, parents' health care utilization is known to influence children's health care utilization, even among privately insured children. This paper examines the health insurance patterns observed within families in 1996. It explores both mixed insurance status and mixed sources of coverage across family members. Implications for the implementation of various policy options to expand child and family health insurance are discussed. Study Design: The paper reports on a cross-sectional analysis of a nationally representative sample of U.S. families. The data come from the first round survey of the Medical Expenditure Panel Survey (MEPS). The final sample included 3,231 families with a total of 6,090 children. Key variables for these analyses included each family member's insurance status and, if covered, the source of coverage. Families were subsequently categorized as having all family members insured, no family members insured, or mixed insurance status. This mixed insurance status group was further refined according to which family members had the coverage: parent(s) only, child(ren) only, child(ren) and one parent, or some children and not others. Sources of coverage were coded in a hierarchical fashion: any private health insurance, Medicaid (with or without other public coverage) and other coverage only. Families were categorized as having all insured family members covered through private sources, Medicaid, other sources or with family members insured through different sources. Characteristics were compared across insurance status and coverage groups using one-way analysis of variance and chi-square analysis.Population Studied: U.S. families with at least one child 18 or younger who was living with at least one of their parents.Principal Findings: 4.5 million American families are partially insured - some family members have health insurance coverage while at least one family member remains uninsured. Partially insured families are similar to completely uninsured families in their young age, low educational attainment, less employment and particularly less full-time work. There were, however, distinct groups of partially insured families. Most commonly (36% of partially insured families), only the parents were covered by private insurance, through their relatively higher wage jobs (38% of mothers and 59% of fathers earned = $7 per hour). Second, typically single-parent families (59%) with low wages (87% of working mothers and 81% of working fathers earned < $7 per hour) had Medicaid coverage for their children while the parent remained uninsured. Third, families in which some of the children had health insurance coverage and others did not were most likely to have an ill or disabled child (24%). Fourth, two-parent families with only one parent and the children insured were of two types: families with young children (74% had a child < 6) who enrolled eligible family members in Medicaid; and families with two employed parents (55%) who enrolled some family members in employment-based health insurance. Only one million families had mixed sources of coverage.Conclusions: These findings highlight the complexity of family insurance arrangements. The ways in which the partially insured differ from completely uninsured families reflect the various routes to health insurance available to Americans. In simple terms, relatively higher wages, the presence of young children or disability provided families with access to health insurance for some, but not all, family members.Implications for Policy: These findings point to several incremental changes that could improve family insurance status: subsidies to assist families in purchasing offered employment-based coverage for spouses and dependent children; relaxing Medicaid eligibility requirements for parents in families with Medicaid-eligible children; and Title XXI variances to provide coverage to low-income working parents. These changes would simultaneously simplify family insurance patterns, ease enrollment of families into public coverage, increase the continuity of benefits received by all family members and thereby may increase the likelihood that children receive needed health care.Primary Funding Source: The Commonwealth Fund

Publication Types:

• Meeting Abstracts

Keywords:

• Child
• Child Health Services
• Child Welfare
• Cross-Sectional Studies
• Eligibility Determination
• Employment
• Family Health
• Health Expenditures
• Humans
• Income
• Insurance Coverage
• Insurance, Health
• Medicaid
• Medically Uninsured
• Parents
• Poverty
• Prevalence
• United States
• economics
• hsrmtgs

Other ID:

• GWHSR0000828

UI: 102272502

From Meeting Abstracts