Children without Health Insurance

By Sarah Bennett-Astesano

Their parents may have jobs, but more than 10 million U.S. children don’t have health insurance. Here’s why and what can be done about it.

It’s one thing to hear the startling numbers: nationally, there are as many as 45 million people without health insurance, and between 8.5 million and 11 million of them are children.

How Insurance Keeps Kids Healthy

Health insurance isn’t the same thing as health care, but insurance makes good care possible.

People who don’t have insurance are less likely to seek and receive either preventative or remedial health treatment. Uninsured children, compared with the insured, are up to eight times less likely to have a regular source of care. Having a regular doctor – someone who follows a child’s medical history – is a predictor for good preventative care. Uninsured children are less likely to receive proper medical care for childhood illnesses such as sore throats, ear aches and asthma, according to reports by the American Academy of Physicians. When care is delivered late and through emergency rooms, besides being disruptive for the child, higher medical costs are passed on to everyone.

– Sarah Bennett-Astesano to find out if your kids are eligible for health coverage through Medicaid and SCHIP.

•  Spread the word. If you have health insurance, but are interested in helping your neighbors who don’t, visit for state and local contacts and ways to get involved. Each year, Covering Kids & Families holds an annual back-to-school campaign. Outreach efforts include participating in health fairs and community events.

Perhaps the most alarming of all, however, is the fact that more than 80 percent of uninsured people come from working families, according to a 2003 report by the Kaiser Commission on Medicaid and the Uninsured, a project of the Henry J. Kaiser Family Foundation, which provides information and analysis on access to health care. Only 19 percent of the uninsured are from families that have no connection to the workforce, according to the report.

And each year, American jobs are less and less likely to come with insurance. The percentage of people who get health insurance coverage from their employers has fallen from 70 percent in 1987 to 61 percent in 2004. This is the lowest level of employment-based insurance coverage in more than a decade, according to the National Coalition on Health Care (NCHC), a nonprofit, nonpartisan coalition comprised of almost 100 organizations working to reform the American health-care system.

"Over 80 percent of uninsured people come from working families."
– Kaiser Commission on Medicaid and the Uninsured

Working parents may be uninsured for many reasons, says Lisa Dubay, an expert on uninsured children at The Urban Institute, a nonprofit, nonpartisan research institute that studies America’s cities and urban populations. “Parents may work for an employer that doesn’t offer health insurance coverage. And even among those employers who do offer coverage, some of the premium contributions are so high that the employee declines it.”

The problem is compounded, Dubay adds, by the fact that as health premiums have increased dramatically in recent years, many employers have had to increase the portion employees have to pay.

 Factors Affecting Coverage

According to the Kaiser Family Foundation/Health Research and Educational Trust 2004 Annual Employer Health Benefits Survey, the following trends have affected the availability of employer-sponsored health insurance:

• Premiums for family coverage have risen 59 percent since 2000, growing at a rate more than five times the rate of inflation.

• The percentage of small firms offering health insurance fell from 68 percent in 2001 to 63 percent in 2004. Roughly 40 million Americans work for firms employing 99 or fewer people, according to the Small Business Administration. This trend disproportionately affects low-income families.

• Cost sharing has increased. Employee spending for health insurance coverage (employee's share of family coverage and deductibles) has increased 126 percent between 2000 and 2004.

• Coverage can be hard to keep during life changes. Employer-sponsored coverage is frequently affected by a change from full-time to part-time work, divorce, or even changing to an employer that requires a waiting period for enrollment.

 Kids Can Get Coverage

“The good news is, approximately 80 percent of uninsured children could be covered,” Dubay says. “Most of these kids are eligible for public health coverage under a state children’s health insurance program – known as SCHIP.”

SCHIP was implemented in 1997 and provides federal matching funds over 10 years to help states expand health-care coverage to the nation’s uninsured children. Each state sets its own guidelines regarding eligibility and services.

“Today, most states cover kids whose family incomes are up to 200 percent of the federal poverty level” – or up to $37,700 for a family of four, says Dubay. “It’s a really important safety net.”

Although the number of uninsured adults continues to rise, nationally the number of uninsured kids has stayed the same.

“The availability of health-care coverage through Medicaid and the SCHIP has played a significant role in helping to keep the overall number of uninsured children from increasing,” notes Sarah Shuptrine, the national program director for Covering Kids & Families, a health coverage initiative focused on outreach, simplification and coordination of Medicaid and SCHIP enrollment policies and procedures, funded by the Robert Wood Johnson Foundation. “As employer-sponsored health-care coverage became less available to children in working families, Medicaid and SCHIP have helped to fill the gap.”

Under these programs, many states have conducted aggressive outreach efforts and focused on making the enrollment process as simple as possible.

“States have made unprecedented efforts to enroll children,” Dubay says. “Volumes of research show that when people know about and understand SCHIP, they enroll.”

Greater Awareness Needed

But nationwide, not enough people know about and understand SCHIP. Getting and keeping kids enrolled remains a challenge, says Shuptrine. “Too many uninsured children are estimated to be eligible for Medicaid or SCHIP, but are not enrolled.”

Researchers cite a range of barriers to enrollment, from language and literacy challenges to parents’ assumption that they won’t be eligible because they are employed.

And, Shuptrine explains, “children enrolled in these programs may have difficulty maintaining their coverage because of eligibility systems that do not effectively communicate with families, which is complicated by a lack of knowledge on behalf of parents about what needs to be done to maintain their children’s coverage once enrolled.”

Challenges to Programs

SCHIP faces challenges. When budgets are tight, some states have taken measures to cap the number of people who can enroll.

In response to state struggles to sufficiently fund their SCHIP programs, Sen. John Kerry (D-Mass.), along with eight Democratic co-sponsors, introduced the “Kids Come First Act of 2005” (S.114) earlier this year. Under this plan, the federal government would pay for all Medicaid outreach and coverage costs for children under age 21 with incomes at or below poverty level. States would pay for a SCHIP or Medicaid coverage expansion to children under age 21 with incomes at or below 300 percent of the poverty level of income – at or below $56,550 per year. Kerry says the plan could be funded by repealing the Bush tax cuts for those making over $300,000 a year.

Whether or not this plan will be enacted remains to be seen.

But family health advocates assert that without increased funding or new legislation, neither SCHIP programs nor private insurance programs are likely to address the needs of moderate-income families who don't have access to affordable employer-sponsored health insurance. And, as insurance premiums continue to rise – premiums may go up by as much as 10 percent in 2006, according to recent reports – more families are likely to join this group.

Meanwhile, physicians’ groups and business groups, such as Physicians for a National Health Program and the National Small Business Association, are calling attention to the need to reinvent the nation's health-care system altogether, separating health-insurance from employment status and creating a seamless system for all Americans.

Sarah Bennett-Astesano is a contributing editor for United Parenting Publications who frequently writes about work and family life issues.

More Resources Online:

Five Things Everyone Should Know About SCHIP.

2004 Annual Employer Health Benefits Survey

Kids Come First Act – Check out the summary of this proposed legislation.

• “No Health Insurance? It’s Enough to Make You Sick,” the American Academy of Physicians.

The Uninsured: A Primer; Key Facts About Americans Without Health Insurance