Category: Health Insurance
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After a Parent Left Employment, One in Five Children Lost Private Insurance Parental job loss is an important trigger for a child’s loss of private health insurance.1 For example, research shows that parental loss of full-time employment doubles the odds that a child will lose private health insurance.2 Until the 1990s, substantial numbers of children lacked health insurance, but with the enactment of the Children’s Health Insurance Program (CHIP) in 1997, followed by changes to Medicaid and CHIP’s 2009 reauthorization, children’s health insurance coverage was expanded through broader eligibility, enrollment simplifications, and outreach efforts.3 From 1997 to 2012, the share of children without insurance fell from 14 percent to 7 percent.4
The growth of public coverage for children notwithstanding, private coverage is still the primary form of children’s health insurance. In 2014, 59 percent of children received coverage from private health insurance.5 But coverage has become less consistent for some children, due to an overall decline in employer-provided private-sector coverage, an increase in switching between public and private sources, and low public health insurance renewal rates.6 Even brief gaps in health insurance produce adverse consequences for children, including fewer medical provider visits over the course of a year, the loss of a primary health care provider, difficulty getting preventive and specialized medical care, and the increased use of emergency department and inpatient hospital visits.7 Loss of employer-based coverage leads to instability in health insurance, gaps in coverage, and more unmet health care needs.8
This brief focuses on children’s loss of private health insurance after a parent left his or her job voluntarily or involuntarily between May 2008 and the end of 2012 (see Box 1 for definitions). The number of uninsured children declined steadily throughout this period,9 and experts project that some of the provisions of the Patient Protection and Affordable Care Act (ACA) of 2010 will foster a continued decline in the percentages of children without health insurance over the long term.10 For most of the period under study, many ACA provisions that have likely served to expand coverage—the mandate that persons obtain health insurance, the state option to expand Medicaid to reach more families, the provision of federal subsidies to purchase coverage, and the ACA requirement for states to transition coverage of children up to 138 percent of the federal poverty line from CHIP to Medicaid—had not yet gone into effect. But since most children are still covered under private health insurance plans, the majority of which are linked to the parents’ employment, understanding the relationship and the characteristics of children who are unlikely to remain covered after a parent leaves his or her job may help identify ways to preserve consistency in coverage. For example, health care providers, administrators, and policy makers can keep watch to ensure that eligible children are quickly connected with public sources of coverage.
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Vulnerable Families Research Program | Children, Employment, Health Insurance, Hispanics, Unemployment | Publication |
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After Years of Decline, Private Health Insurance Rates Among Children Grew in 2014 Rates of private health insurance coverage for children increased between 2013 and 2014 for the first time since 2008, the first year in which the American Community Survey collected data on health insurance (see Figure 1). The rise corresponds with the implementation of the individual mandate under the Affordable Care Act (ACA), the opening of state and federal insurance exchanges, and an improving employment market.
Between 2008 and 2014 (the most recent data), rates of children’s coverage grew nearly 4 percentage points; to 94 percent. Growth in public insurance, such as Medicaid and the Children’s Health Insurance Program (CHIP), was largely responsible for these gains (up 10.8 percentage points since 2008), while rates of private insurance coverage fell concurrently (down 5.6 percentage points). But between 2013 and 2014, the combined rise in public coverage (0.8 percentage points) and private coverage (0.4 percentage points) produced the second-largest overall gain—1.1 percentage points—in children’s insurance rates in the seven-year span. The largest increase—1.4 percentage points—occurred between 2008 and 2009 when Congress and the Obama Administration reauthorized CHIP.
Private insurance rates rose most in the rural Midwest and South as well as in Western cities in 2014, while public insurance grew most significantly in suburban places in the Northeast, South, and West.
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Vulnerable Families Research Program | Children, Health Insurance | Publication |
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Children's Health Insurance in New Hampshire: An Analysis of New Hampshire Healthy Kids New Hampshire has been successful in achieving one of the lowest uninsurance rates for children in the country - 6 percent in 2005 (U.S. Census Bureau). The extent to which New Hampshire Healthy Kids has contributed to the state's success in achieving this low rate is the focus of this brief.
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Evaluation, New Hampshire | Children, Health, Health Insurance, New Hampshire, Safety Net | Publication |
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Coverage Rates Stabilize for Children’s Health Insurance Recognizing that adequate health care is key to childhood development and long-term health, policy makers expanded public programs to provide children with health insurance: first, Medicaid in 1965 and, in 1997, the State Children’s Health Insurance Program (SCHIP). In April of 2015, Congress renewed SCHIP for two additional years. Therefore, providing children with health coverage has been recognized by lawmakers as key to childhood development and long-term health. This brief uses data from the American Community Survey to estimate children’s health insurance coverage from 2008–2013 across the United States as well as by region, place type, and type of coverage.
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Vulnerable Families Research Program | Children, Health Insurance | Publication |
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Data Snapshot: Fewer Young Adults Lack Health Insurance Following Key ACA Provisions The share of people without health insurance has dropped dramatically since the implementation of the Affordable Care Act (ACA), but declines have been most dramatic among young adults age 19 to 25. In 2008, one-in-three 23-year-olds were uninsured, likely reflecting their graduation from college and therefore, their ineligibility to be covered on parental plans. Beginning in 2010, the ACA allowed young adults to remain on their parents’ plans until age 26; the orange line in Figure 1 reflects this shift, as 26-year-olds, rather than 23-year-olds, became the most often uninsured by 2013.
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Vulnerable Families Research Program | Health Insurance, Poverty, Young Adults | Publication |
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Data Snapshot: Nine Million Publicly Insured Children in the Twelve States Facing Federal CHIP Cutoff by End of Year Funding for the Children’s Health Insurance Program (CHIP)—the federal program that extends health insurance coverage to low income children not eligible for traditional Medicaid—officially expired on September 30, 2017. Given that states implement CHIP in different ways, states will run out of funds at different times, with twelve states exhausting their federal allotment by the end of 2017 (see Figure 1).
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Vulnerable Families Research Program | Health Insurance, Safety Net | Publication |
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Full-Time Employment Not Always a Ticket to Health Insurance The majority of Americans—55.7 percent in 2016, according to the Census Bureau—access health insurance through employer-based plans.1 However, employment does not always result in health insurance coverage, and not all those who report working full time, year round are covered by an employer-based plan. In particular, many low-income workers are unable to access health insurance through their employers.
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Vulnerable Families Research Program | Employment, Health, Health Insurance | Publication |
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Health Insurance Among Young Adults Rebounds Post Recession: More Become Dependents on a Parent's Plan After ACA Extends Coverage to Adult Children While much of the existing research explores young adults' insurance only in the post-recession period (that is, 2010 to present), authors Michael Staley and Jessica Carson assess young adults' rates of coverage within and beyond the context of the recession by examining changes across the entire 2007 to 2012 period.
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Vulnerable Families Research Program | Children, Employment, Health, Health Insurance, Young Adults | Publication |
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Hispanic Children Least Likely to Have Health Insurance This policy brief examines health insurance coverage of Hispanic children and its relationship to their citizenship status, their parents’1 citizenship status, parents’ insurance coverage, language spoken at home, and their state’s Medicaid expansion policies.
Hispanic Children Are Least Likely to Have Health Insurance
In 2014, 94 percent of U.S. children had health insurance.2 Although this is a record high for children’s coverage, 4.3 million children still remain without health insurance, and Hispanic children make up a disproportionate share of this group.
Hispanic children have historically had the highest rates of uninsurance among children of any racial/ethnic group.3 In 2014, the most recent year for which data are available, 95.4 percent of non-Hispanic white children, 95.3 percent of black children, and 94.4 percent of multiracial children had health insurance coverage. In comparison, only 90.3 percent of Hispanic children were covered, leaving more than 1.7 million Hispanic children uninsured. Hispanic children in rural areas are less likely to have health insurance than Hispanic children in urban areas (9.4 percent versus 12.2 percent, respectively).4
Nearly 40 percent of all uninsured children are Hispanic, although Hispanic children make up only 24.3 percent of children in the United States (see Figure 1). By contrast, though nearly 52 percent of U.S. children are non-Hispanic white, they comprise only 40 percent of uninsured children. Black, non-Hispanic children account for 13.6 percent of children in the United States but just 10.8 percent of uninsured children.
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Vulnerable Families Research Program | Children, Health Insurance, Hispanics | Publication |
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Lack of Protections for Home Care Workers: Overtime Pay and Minimum Wage This brief examines overtime hours and hourly wages among home care workers (home health aides and personal care aides) and compares them with hospital and nursing home aides. These aides engage in similar work for their clients, even though they work in different institutional settings.
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Vulnerable Families Research Program | Employment, Health Insurance, Safety Net, Wages | Publication |
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More Than 95 Percent of U.S. Children Had Health Insurance in 2015 Enrolling all children in health insurance is a primary goal of health care advocates. Children who have health insurance have better access to health care and, as a result, experience gains in a variety of well-being measures, including health and school attainment.1 Most children are covered by private insurance,2 but public insurance available through the Children’s Health Insurance Program (CHIP), Medicaid, and the Affordable Care Act (ACA) has significantly contributed to gains in insurance rates among children.3 Providing access to health care for children living in poverty was central to Medicaid during the “The Great Society” project of the 1960s. CHIP was adopted in 1997, which aimed to enroll low-income children whose parents’ income was too high to qualify for Medicaid, but too low to afford private coverage. Despite some debate regarding the income level at which children ought to qualify for public coverage, legislation to insure children has received bipartisan support.4 Policy and advocacy efforts to insure children have been effective: a higher share of children were enrolled in health insurance in 2015—95.2 percent—than at any time since these data started being collected in 20085 (see Table 1). Rates of coverage increased 1.2 percentage points between 2014 and 2015. By region, the largest gains occurred in the South (1.2 percentage points) and the West (1.9 percentage points). These two regions traditionally have had the lowest rates of coverage and therefore the most opportunity for growth. Yet even after marked improvements in children’s coverage in both, they still lag behind the Northeast and Midwest. Rates of coverage also grew across all place types (cities, suburbs, and rural places) between 2014 and 2015 except in Midwestern cities, where the measured gain was not statistically significant. The most substantial gains occurred in Western and Southern suburban and rural places.
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Vulnerable Families Research Program | Children, Health Insurance, Safety Net | Publication |
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New Hampshire Employees Working in Small Firms Lack Access to Paid Family and Medical Leave In this brief, author Kristin Smith reports that In December 2022, just prior to the launch of the NH Paid Family and Medical Leave Program, 40 percent of NH workers did not have access to paid medical, parental, or family leave. In its first year, the program has reached 14,712 workers or less than 3 percent of Granite State workers.
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New Hampshire | Employment, Health Insurance, New Hampshire | Publication |
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Over 80 Percent of New Hampshire Residents Support Paid Family and Medical Leave Insurance Paid family and medical leave helps workers manage their work and family responsibilities by allowing them to take extended time away from work while receiving some wage replacement and without the threat of being fired. Yet, access to paid family and medical leave to care for a sick family member, a new child, or tend to one’s own illness is uneven: workers who typically have access are more likely to be full time, have higher education and earnings, and work in larger firms than workers with no access. Support for a statewide paid family leave program is widespread in New Hampshire. In a winter 2016 Granite State Poll, 82 percent of New Hampshire residents said they support a paid family and medical leave insurance program.
Although New Hampshire currently does not have a paid family and medical leave law or program, these policies are gaining momentum across the United States. California, New Jersey, Rhode Island, and New York have enacted family and medical leave legislation (the New York law takes effect in January 2018), and many other states are considering similar legislation.
At the federal level, the Family and Medical Insurance Leave Act (the FAMILY Act) would create a national paid family and medical leave insurance program to provide workers with time to care for family members, a new child, or themselves when seriously ill. Understanding the level and nature of support for a program in New Hampshire will provide policy makers and stakeholders with useful information when considering the needs of Granite State workers and the opportunities for maintaining a strong workforce.
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New Hampshire, Vulnerable Families Research Program | Family, Health, Health Insurance, New Hampshire | Publication |
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Public Insurance Drove Overall Coverage Growth Among Children in 2012 Using data from the American Community Survey, this brief examines the rates of health insurance coverage among children under 18 in the United States by region and by rural, suburban, and central city residence between 2008 and 2012.
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Vulnerable Families Research Program | Children, Health Insurance | Publication |
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Rates of Public Health Insurance Coverage for Children Rise as Rates of Private Coverage Decline This brief uses data from the 2008, 2009, and 2010 American Community Survey to document changes in rates of children’s health insurance, between private and public. The authors report that, nationally, private health insurance for children decreased by just under 2 percentage points, while public health insurance increased by nearly 3 percentage points.
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Vulnerable Families Research Program | Children, Health Insurance | Publication |
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Rural Children and Those Residing in Central Cities Have Lower Rates of Health Insurance Coverage and are More Often Covered by Public Plans This Carsey brief looks at the geographic distribution of health insurance for children. Based on data from the 2008 American Community Survey, it includes such findings as one in ten children are still uninsured, insurance rates vary considerably by geographic area, and rural children are most likely to depend on public plans for their health care.
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Vulnerable Families Research Program | Children, Health Insurance, Rural, Urban | Publication |
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Rural Children Increasingly Rely on Medicaid and State Child Health Insurance Programs for Medical Care Despite a flurry of reports on health insurance coverage for children, virtually none of them have examined the unique situation of rural families where one-fifth of all the nation's poor children live. This brief takes an in-depth look at the health insurance programs, such as SCHIP and Medicaid, which rural children rely on for medical care.
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Vulnerable Families Research Program | Children, Health, Health Insurance, Poverty, Rural, Safety Net | Publication |
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Support for Paid Family and Medical Leave in New Hampshire In October 2018, the last period for which we conducted public opinion research, support for a paid family and medical leave program was high. Seventy-eight percent of New Hampshire residents stated support for a program that would provide a portion of wages to workers taking leave for personal or family medical reasons.
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New Hampshire | Health Insurance | Publication |
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The Impact of State Medicaid Expansion Under the Affordable Care Act on Health Insurance Coverage at the County Level Counties and states with large shares of uninsured risk having to contend with a range of health and economic impacts, such as reduced workplace productivity, unsustainable demands on emergency departments, higher tax burdens resulting from uncompensated care costs, and deteriorating health care quality due to reductions in public spending.1
In 2013, before the implementation of major provisions of the Affordable Care Act, 41 million U.S. adults age 19–64 had no health insurance. Coverage varies considerably by geographic location. For instance, in 2013 county-level coverage rates ranged from a high of 96 percent in Norfolk County, Massachusetts to a low of 57 percent in Willacy County, Texas.2
The purpose of Medicaid expansion under the Affordable Care Act was to make health care more accessible to low-income populations. By early 2015, 28 states had expanded Medicaid eligibility (see Figure 1). The expansion by some states but not by others provides a unique opportunity to examine the impact of this new policy on changes in health insurance coverage. Moreover, as the newly elected Republican President and the Republican-controlled Congress consider the future of health care reform, understanding the efficacy of components of the Affordable Care Act, such as Medicaid expansion, will be essential for continuing efforts to increase coverage rates and subsequently minimize the associated consequences of low coverage rates. This research identifies differences in changes in insurance coverage rates for non-elderly adults (age 18–64) from 2013 to 2015 between counties in states that did and did not expand Medicaid. The analysis also identifies the county-level factors that contributed to these differences. The year 2013 is used as the starting point because Medicaid expansion did not begin until January 1, 2014.3
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Vulnerable Families Research Program | Health Insurance, Safety Net | Publication |
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The Long-Term Unemployed in the Wake of the Great Recession Using the Annual Social and Economic Supplement of the Current Population Survey, this brief outlines the demographic and economic characteristics of the long-term unemployed and compares them with their short-term unemployed counterparts. It also describes changes in the composition of the long-term unemployed since the start of the Great Recession.
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Vulnerable Families Research Program | Employment, Health Insurance, Rural, Unemployment, Urban | Publication |