FOR IMMEDIATE RELEASE: August 23, 2021
Contact: Adam Gaffney, M.D., M.P.H., agaffney@cha.harvard.edu
Steffie Woolhandler, M.D., M.P.H., swoolhan@hunter.cuny.edu
Clare Fauke, communications specialist, Physicians for a National Health Program, clare@pnhp.org
In a study published Monday, researchers at Harvard Medical School and the City University of New York at Hunter College find that the number of uninsured children rose from 5.9 million to 6.3 million between 2016-19. During that same period, the number of children with inadequate coverage (a group often labeled “underinsured”) increased from 16.2 million to 18.1 million.
The study analyzed data on 128,621 children from the National Survey of Children’s Health. The researchers considered children uninsured if they lacked coverage at any point during the year. Children were classified as underinsured if their parent/guardian reported that their insurance never or only sometimes covered the services and providers they needed, or that it imposed unreasonable out-of-pocket costs—following the definition used in earlier studies.
The study found that the proportion of children with inadequate insurance (either uninsured or underinsured) was lower in ACA Medicaid expansion states (30.9%) than in non-expansion states (35.3%). Somewhat surprisingly, underinsurance was more common among privately-insured (34.8%) than publicly-insured (17.5%) children, likely reflecting the high copayments and deductibles in many private plans.
The researchers found that nearly one in three children with serious chronic illnesses or impairments were inadequately insured, including an average of 154,349 children with diabetes each year, 304,292 with heart disease, 1,902,839 with attention-deficit disorder, and 2,081,189 with asthma.
“Children’s health coverage was deteriorating even while the economy was booming,” noted Dr. Steffie Woolhandler, a primary care physician and Distinguished Professor at the City University of New York’s Hunter College and Lecturer at Harvard Medical School. “On the eve of the COVID-19 pandemic millions of American families couldn’t afford the care their children needed, increasing their medical and financial vulnerability,” Woolhandler added.
Dr. Adam Gaffney, a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance, noted, “Much recent debate has centered on the critical need to expand coverage for older adults. Our findings indicate that there are also huge coverage gaps for kids. Some proposed reforms—like covering all children under Medicaid—would offer a partial fix. But we found that even kids with Medicaid often couldn’t get the care they needed. Only universal national health insurance reform can assure access to care for both kids and adults.”
“Medical Uninsurance and Underinsurance Among US Children: Findings From the National Survey of Children’s Health, 2016-2019,” Adam Gaffney, M.D., M.P.H.; Samuel Dickman, M.D.; Christopher Cai, M.D.; Danny McCormick, M.D., M.P.H.; David U. Himmelstein, M.D.; Steffie Woolhandler, M.D., M.P.H.; JAMA Pediatrics.
Published online first August 23, 2021
Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 24,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.