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Health Insurance: A Family Affair

Extending health coverage to the parents of children enrolled in public insurance programs may not only reduce the number of uninsured adults, it may be the best way to cover more uninsured children. According to a new Commonwealth Fund report, Health Insurance: A Family Affair, by Jeanne M. Lambrew of George Washington University, uninsured rates for eligible children are far lower in states where Medicaid and the State Children's Health Insurance Program (CHIP) have been expanded to include their parents.

Medicaid eligibility requirements for parents are extremely stringent in many parts of the country. According to the study, some states make Medicaid coverage available only to parents making less than 50 percent of the federal poverty level. This means that many low-income, working parents earn too much to qualify for public coverage but too little to afford private insurance. Extending Medicaid or CHIP to parents, says the author, would remove the fear of losing affordable health coverage for those leaving welfare to join the workforce.

The United States has more than 9 million uninsured parents, 6.2 million of whom have incomes below 200 percent of the poverty level ($36,000 for a family of four). Half of all low-income people are uninsured parents and children. But while the uninsured rate has decreased for children, it has risen for parents. The proportion of low-income parents lacking health insurance climbed from 31 percent to 33 percent from 1996 to 1999. The number of uninsured children, meanwhile, fell by one million from 1998 to 1999.

Low-income children with insured parents are nearly twice as likely to have health coverage as children with uninsured parents. Around 90 percent of low-income children whose parents have coverage are themselves insured. In contrast, less than half (48%) of children with an uninsured parent have coverage.

States that have extended coverage eligibility to parents above the poverty level have uninsured child rates that are nearly half those of states restricting eligibility to parents below poverty. In 1998, about 25 percent of low-income children were uninsured in states that had not expanded coverage for parents, compared with an average of 14 percent in states that had taken this step. Other studies have shown that insuring parents above the poverty level is also good for children's health. Insured parents with a regular health care provider are more likely to ensure that their children receive regular preventive care.

Facts and Figures

  • Uninsured rates for low-income parents vary widely: Arizona and New Mexico have the highest rates (47%), Hawaii the lowest (11%).
  • The uninsured rate for low-income parents is more than 40 percent lower in states that have expanded public coverage to parents living above the poverty level than it is in states that have not.
  • Nearly three of five uninsured parents of Medicaid- or CHIP-eligible children are women.
  • About 75 percent of uninsured children eligible for Medicaid or CHIP have at least one uninsured parent.

Publication Details



Health Insurance: A Family Affair, Jeanne M. Lambrew, George Washington University., The Commonwealth Fund, May 2001