Medically Uninsured Children in the United States: A Challenge to Public
Oberg, Charles N., Journal of School Health
As we proceed into the 1990s we are faced with a health care trend which is affecting an increasing proportion of children in the United States. It is estimated that there are over 37 million Americans who lack health insurance coverage, and children represent the largest segment of the uninsured population. (1) This article is an examination of the nature and extent of the problem presented by medically uninsured children. The characteristics of the uninsured population are discussed with a description of how age, family income, and employment status disproportionately affect families with children resulting in their overrepresentation among the uninsured. The Medicaid program, or Title XIX of the Social Security Act, and its historically inadequate response to this growing problem is examined and the relationship between insurance status and children's health and development is discussed. Finally, recent public policy initiatives that have been either enacted or proposed to address this inequity in the health care system are reviewed. The article concludes with a recommendation calling for the establishment of a "Universal Maternal and Child Health Program" to assure access to this vulnerable population.
CHARACTERISTICS OF MEDICALLY UNINSURED
The number of uninsured Americans has increased an estimated 30% during the past decade. (2) The uninsured are not a homogenous group of individuals, but rather a diverse population that is becoming increasingly alienated and disenfranchised from the health care system. This section is an exploration of the key factors that characterize the uninsured, specifically age, income, and employment status.
The age distribution of the uninsured demonstrates the inequity faced by children. It is estimated that the largest segment of the uninsured population are the 12.2 million children less than 18 years of age. (3) Another 7 million children may be insured for only part of the year. (4) If the age limit is extended to include young adults, more than 56% of the uninsured are under 24 years of age. (5) Inequities in coverage are particularly evident for children between the ages of 0 and 2 years and for adolescents and young adults aged 18 to 24 years. (4) The lack of insurance among 18- to 24-year-olds is of particular concern for young women in need of maternity care. Quality comprehensive prenatal care is becoming less accessible to a large and growing proportion of women because they lack health insurance coverage for maternity care. Whereas the uninsured rate for the general population is 17%, it is estimated that three women in five (59%) 15 to 19 years old and one third of women 20 to 24 years old have no insurance for maternity care during these prime childbearing years. (8) The issue of inadequate access to prenatal care during this age period is critical, because it may result in increased neonatal morbidity and mortality.
Income is another key demographic variable that provides information on the uninsured and the relationship between health insurance and families with children. Before 1965 and the creation of Medicaid, access to health insurance was best characterized as a linear function with increasing family income assuring a greater likelihood of health insurance coverage. (7) That pattern of availability, however, has changed. The poorest poor are at least partially covered by Medicaid. In addition, the financially secure families of the middle- and upper-income strata typically have an employer-subsidized health care plan or individually financed health coverage. However, there is a large segment of the population who are poor or near poor who lack health insurance coverage.
Americans living below the federal poverty level still represent the largest segment of the uninsured, accounting for 12.6 million or 35.6% of uncovered persons. (8) Because children account for the largest segment of all Americans in poverty (40%), the link between income and health insurance coverage for children is particularly significant. …