As a new administration and Congress consider ways to lower the number of uninsured Americans, a new study supported by The Commonwealth Fund reveals that expanding existing private and public coverage to include entire families would be an efficient means of reaching millions of the uninsured.
In "Patterns of Insurance Coverage Within Families with Children" (Health Affairs, Jan./Feb. 2001), Karla Hanson of the New School University analyzes data on 32 million U.S. families with children. In more than three-quarters of families all members have health coverage, but in a surprisingly high proportion of families-one of seven-only some members are insured. Hanson finds that:
- In 1.6 million families, the parent (or parents, if a two-parent family) is covered while the children are uninsured. These are most likely families in which a parent has coverage through his or her job but cannot afford higher premiums to cover the entire family.
- In 1.3 million families, the children are insured but the parent or parents are uninsured. The majority of these are low-income families in which the children are covered by Medicaid but the parents are ineligible.
- In 1.6 million families, either one parent is uninsured and the other parent and children are insured, or some children are insured and some are not. In the latter case, families are more likely to have a sick or disabled child.
Based on her findings, the author proposes three paths to complete family coverage:
- Providing subsidies to low-income parents to help them pay the higher premiums for family coverage.
- Allowing federal Medicaid and State Children's Health Insurance Program (CHIP) funds to be used to cover older children and low-income parents.
- Expanding Medicaid coverage of disabled persons to include their uninsured family members, who often face financial burdens because of their role as caregivers.
Hanson points out that providing whole-family coverage can simplify complex insurance arrangements that result from a patchwork system of public and private programs. Moreover, fully insured families have better access to health services and greater continuity in their care.
Facts and Figures
- Approximately 4.5 million U.S. families with children (14%) are only partially insured, meaning that some members have health insurance and some do not.
- About 65 percent of families in which the children are insured but the parents are uninsured are low-income families.