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Trends in Health Insurance and Access to Medical Care for Children Under Age 19 Years: United States, 1998-2003

Objective—The State Children’s Health Insurance Program (SCHIP) was enacted in 1997 in order to improve health insurance coverage for children under 19 years of age in poor and near poor families. This report provides national estimates of trends in access to medical care by health insurance coverage and poverty status for these children since enactment of SCHIP. Data from the 1998–2003 National Health Interview Surveys (NHIS) are used. This report is a companion piece that complements estimates from the NHIS Early Release Program. Methods—The NHIS is a multistage probability sample survey conducted annually by interviewers of the U.S. Census Bureau for the Centers for Disease Control and Prevention’s National Center for Health Statistics and is representative of the civilian noninstitutionalized population of the United States. Information about children from approximately 14,000 interviews for each year from 1998 to 2003 is presented to examine trends in access to health care. Results—The percent of poor and near poor children under 19 years of age who were uninsured decreased by approximately 25% from 1998 to 2003. The greatest increase in public health insurance coverage was among children who were near poor; that rate more than doubled from 22.5% in 1998 to 46.0% in 2003. Among near poor children, those who were uninsured were more likely to have unmet medical need (35.5%) than those with public (9.4%) or private coverage (14.4%). In 2003, 14.1% of poor children who had public coverage visited the emergency room (ER) two or more times in the previous year compared with 7.8% of poor children who were uninsured.