Children's Health 1996

MEPS Chartbook No. 1

This MEPS Chartbook is from the Medical Expenditure Panel Survey of the Agency for Health Care Policy and Research. In this era of rapid changes in our health care system, it is important to assess periodically where we stand. This report presents the latest available information concerning three key elements related to children's health.

The first section of the report presents data on the health insurance status of children in the United States. Since having health insurance is just one factor that may influence children's health and well-being, the second section of the report addresses access to health care, with a focus on usual source of care and barriers to care. Finally, the third section of the report turns to the motivating force behind our Nation's interest in children's health insurance and access to care: the health status of children.

By Margaret E. Weigers, Ph.D., Robin M. Weinick, Ph.D., Joel W. Cohen, Ph.D.

Executive Summary
Introduction—Health Policy for Children
Source of Data for This Report
Section 1—Children's Health Insurance
Section 2—Children's Access to Health Care
Section 3—Children's Health Status
Conclusions
Looking ahead—Future MEPS Data on Children
References

Executive Summary

What were we doing well in 1996?

On the other hand...

Nearly 11 million children were uninsured.
Of all children who were uninsured, approximately 90% lived in households with a working adult.
Many children remain uninsured despite being eligible for Medicaid. MEPS estimates indicate that over 3 million young children and more than a million older children were eligible but uninsured.
20% of uninsured children lacked a usual source of health care.
Of families with barriers to receiving needed care, 60% said the main reason they did not get care was because they could not afford it.
2.8 million children were in fair or poor health.
Only 43% of children in fair or poor health had private insurance, while 42% had public coverage.

Introduction

Health Policy for Children

High-quality health care is important to the well-being of America's children. Recent policy changes have attempted to increase children's health insurance coverage and access to care so that children can obtain health care that is appropriate to their developmental needs. In the last decade, the Medicaid program has been expanded to decrease the proportion of children who are uninsured. However, a substantial number of children still lack health insurance and adequate access to care. Consequently, they risk health problems associated with not being immunized, not receiving appropriate well-child care, and not receiving timely treatment for acute health problems.

Return to Contents

Source of Data for This Report

The estimates presented in this report are drawn from the Medical Expenditure Panel Survey (MEPS). MEPS is the third in a series of medical expenditure surveys conducted by the Agency for Health Care Policy and Research. It is a nationally representative survey that collects detailed information on health status, health care use and expenses, and health insurance coverage of individuals and families in the United States.

These data come from the first and second rounds of interviewing for the Household Component of the 1996 panel of MEPS. (See Note 1). The estimates presented here are nationally representative of noninstitutionalized children under age 18. In some cases, totals may not add precisely to 100 percent as a consequence of rounding. Where shown, the racial category "white" includes children identified as white as well as a very small number of children identified as American Indians, Aleuts, Eskimos, or other races.

MEPS data are released to the public in a number of formats, including public use data files and the printed "MEPS Research Findings" and "MEPS Highlights" series. The numbers shown in this Chartbook are drawn from a variety of the Research Findings reports, as well as additional analyses conducted by the MEPS staff. Select to access references for this report.

Return to Contents

Note 1. Data collection for Round 1 took place between March and July 1996 and asked about health-related issues for the period from January 1, 1996, to the date of the Round 1 interview. Round 2 data collection occurred during the period from August to November 1996 and asked survey respondents to report on health-related issues between the date of the first interview and the date of the second interview. All data concerning health insurance, health status, and demographics presented in this chartbook come from Round 1 of the survey. Health insurance and health status estimates should therefore be interpreted as estimates for experiences during the first half of 1996. Information on access to care was obtained in Round 2 of the survey; however, the questions on access to care generally did not ask about a specific time period.

Section 1—Children's Health Insurance

Health insurance plays a critical role in ensuring that children obtain timely medical care that is appropriate to their developmental needs. In an era of high health care costs, individuals' difficulty affording medical care has made health insurance essential for ensuring that children's health services are both accessible and affordable.

Children's health insurance: Where do we stand?

15.4% of the Nation's children were uninsured throughout the first half of 1996.
One-fifth (20.8%) of children had public coverage.
Almost two-thirds (63.9%) of the Nation's children were covered by private health insurance.

Select to access Figure 1 (3 KB).

Who are the uninsured children?

Nearly 11 million children in America were uninsured throughout the first half of 1996. These children represent 15.4% of all children in the United States.
Of all children uninsured throughout the first half of 1996, about 90% were in households with a working adult.
Children in families with a working adult represented over a fifth (22.1%) of the non-elderly uninsured population.

Are minority children at greater risk of not having health insurance?

Hispanic children were the most likely to be uninsured: 27.7% of Hispanic children, 17.6% of black children, and 12.3% of white children were uninsured.
White children were far more likely to have private health insurance (73.9%) than either black (41.7%) or Hispanic children (39.8%).
Nearly a third (32.5%) of Hispanic children and 40.8% of black children had public health care coverage, compared to only 13.8% of white children.

Select Figure 2 (3 KB).

Are children in single-parent families at greater risk of not having private health insurance?

Approximately one-quarter of children in the United States live in single-parent families.
Roughly one in five children (19.8%) in single-parent families were uninsured during the first half of 1996, compared with 13.6% of children in two-parent families.
Nearly three-quarters (73.7%) of children in two-parent families had private insurance, compared with only 38.7% of children in single-parent households.
Children in single-parent families were three times more likely to have public insurance than children in two-parent families (41.5% compared to 12.7%).

Select Figure 3 (5 KB).

How do parents' employment and education levels affect children's health insurance?

Employment

Children living with two employed parents were the most likely to have employment-related private health insurance.

79.1% of children living with two employed parents had health insurance through an employer.
58.8% of children in two-parent households with one working parent had health insurance through an employer.
51.1% of children in single-parent households with a working parent had employment-related health insurance.

Education

Adults' educational level greatly influenced the probability of children being insured.

27.6% of children living in families where adults had less than a high school diploma were uninsured.
Only 10.6% of children living in families where adults had more than 12 years of education were uninsured.

How did recent Medicaid expansions affect the health insurance status of children?

Medicaid expansions between 1987 and 1996 resulted in more generous eligibility rules for children. During the same period, the proportion of children covered by Medicaid increased from 12.4% to 20.9%.
Young children were targeted by the expansions, and 1996 estimates show that the largest increase was among that group. Medicaid enrollment among children 5 and under nearly doubled, from 13.8% in 1987 to 25.8% in 1996.
Approximately 9.4 million children under the age of 18 who were eligible for Medicaid in 1996 would not have qualified for coverage under the 1987 rules.

Select to access Figure 4 (5 KB).

Are all the children who are eligible for Medicaid enrolled in the program?

Medicaid expansions have increased access to health insurance for children. However, many Medicaid-eligible children still are not enrolled.

Of the estimated 16.6 million children age 12 and under who were eligible for Medicaid, approximately 3.3 million (19.7%) were uninsured during the first half of 1996, 4.4 million (26.6%) had private coverage, and 8.9 million (53.7%) had public coverage. (See Note 2.)
In addition, MEPS estimates indicate that more than 1 million children age 13 and over were uninsured despite being eligible for Medicaid.

Select to access Figure 5 (3 KB).

Note 2. Estimates include children made eligible under both Federal and State Medicaid expansions. Children age 12 and under are defined as those born after September 30, 1983. Eligibility was predicted for each person in Round 1 of MEPS based on age, gender, pregnancy status, family composition, employment status of parents, and family earned income. Earned income was computed using data on wages and hours worked for all jobs as of the interview week. The Medicaid eligibility measure does not account for disabled children or adults.

The estimates presented here for young children differ from other widely cited estimates for children age 10 and under, primarily because 11- and 12-year-olds who became eligible under the Federal expansion rules in effect in 1996 are included. In addition, children who are eligible under optional State expansions are included, and eligibility is predicted using weekly earned income rather than annual income from all sources.

What is the employment status of parents of children on Medicaid?

40.1% of Medicaid-enrolled children under the age of 18 lived with one employed parent.
An additional 12.7% of Medicaid-enrolled children under 18 lived with two employed parents.

Select to access Figure 6 (3 KB).

Return to Contents
Proceed to Next Section