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Gaps in Children's Health Insurance: Magnitude, Consequences, Barriers and Implications for Policy and Research

Abstract This paper considers the affect of health insurance on children in the United States. Four topics are addressed. First, estimates of the number of children with no insurance or discontinuous coverage are presented. Second, consequences of being uninsured or having gaps in health insurance are considered. Third, a summary of barriers to increasing the extent and continuity of children's health insurance is outlined. Fourth, implications for policy and research are briefly discussed. It has been well established that heath care in the United States is not the main determinant of health status of the population (McGinnis and Foege, 1993). As a nation, we spend by far more than any other country, yet our population has worse health status as measured by numerous indicators among the 30 developed countries comprising the Organization for Economic Cooperation and Development (Schroeder, 2007). This is due, in part, to determinants of health status that are not addressed by the health care system such as genetic predispositions and, more importantly, lifestyle choices (e.g., diet, physical activity, tobacco, alcohol and drug use, sexual practices, among others), and environmental and social factors (e.g., poverty, employment, housing, socially disintegrated communities, etc.). The ways in which the U.S. health care system is structured and the kinds of health care services that are emphasized (e.g., tertiary care versus primary and secondary prevention), further limit the extent to which health care contributes to health promotion and disease prevention. Nevertheless, availability and accessibility to consistent and high quality health care does influence the health status of the U.S. population, particularly for those at increased risk of various health problems and those with special health care needs (Hoffman and Paradise, 2008), both of which disproportionately affect poor and minority youth. Indeed, universal health insurance coverage for the elderly may explain, at least in part, why one measure of health status for which the U.S. ranks higher than many nations in the Organization for Economic Cooperation and Development is life expectancy among those over 65 years of age (Schroeder, 2007). This paper considers the affect of health insurance on children in the United States. Four topics are addressed. First, estimates of the number of children with no insurance or discontinuous coverage are presented. Second, consequences of being uninsured or having gaps in health insurance are considered. Third, a summary of barriers to increasing the extent and continuity of children's health insurance is outlined. Fourth, implications for policy and research are briefly discussed.