One-third of US children uninsured from 2016-2019, study finds

A third of U.S. children were uninsured from 2016 to 2019, according to a study published recently in Pediatrics.

The study found that even before the COVID-19 pandemic, underinsurance rose significantly among U.S. children due to increased rates of insurance inadequacy.

Using data from the National Survey of Children’s Health, researchers determined that among 73.3 million children aged 0 to 17 years in the 3-year period, the proportion of U.S. children experiencing underinsurance rose 3.4% (95% CI, 1.9%-4.9%) from 30.6% to 34% — amounting to an additional 2.4 million uninsured children from the period before.

Just more than two-thirds of their peers (67.6%; 95% CI, 67- 68.1%) had continuous and adequate insurance coverage during that period.

“We found that insurance inadequacy experienced as unreasonable out-of-pocket medical expenses increased significantly, in line with studies of U.S. adult underinsurance showing a doubling of insurance inadequacy because of high out-of-pocket costs in the past decade,” the researchers wrote.

“High out-of-pocket costs are problematic because they increase the risk of forgone care and the burden on a family’s finances,” they wrote. “This rise in unreasonable out-of-pocket expenses is likely due to the broader pattern of commercial insurance plans becoming more expensive and transferring costs to individuals and families.”

The researchers said employer-sponsored insurance plans now account for more than 11% of the national median household income, with families in non-Medicaid expansion states experiencing even higher cost-sharing burdens because of increases in premiums, copayments and deductibles.

“High-deductible health plans have also come to dominate marketplace products, with almost 90% of marketplace enrollees selecting high-deductible products,” they wrote. “These trends also help explain why we found children with private insurance were significantly more likely to be underinsured, further building the evidence base that public insurance better protects families from out-of-pocket costs.”

The researchers said reforms are needed to address the problem.