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Solving the Riddle of Patchwork Family Coverage

By Neda Semnani, CQ Staff

October 21, 2008 -- When Americans are uninsured, it may not be a family affair. Because of the nation's patchwork coverage system, kids who have health benefits may have uninsured parents, and parents with health coverage may have uninsured kids. If only some members of a family have insurance, a new study notes, the most typical pattern is that parents go without while their children are insured—particularly since the 1997 creation of the State Children's Health Insurance Program (SCHIP). Still, for policy makers trying to figure out how to widen coverage, covering uninsured kids whose parents have health insurance benefits is a big part of the puzzle, the study suggests.

Led by Oregon Health & Science University researcher Jennifer DeVoe, the study found that some 2.3 million children a year are uninsured even though at least one of their parents has health insurance. That means that slightly under one-third of the nation's 9 million uninsured children have one or more parents with coverage.

These parents are more likely to be covered through private insurance or employer-based insurance where the costs for including their child or family can be a significant portion of or, in some cases, exceed their salaries.

According to the study, this group of uninsured children is more likely to be from low- and middle-income families rather than from among the nation's poor. These insured parents are more likely to have limited or low levels of education and are more likely to be of Hispanic origin, heading a single parent household, and living in the geographic South or the West of the country.

In order to appropriately address this gap in coverage, the researchers recommend "increasing public outreach and retention efforts to keep eligible children enrolled in public insurance benefits, easing prohibitive barriers, and expanding the SCHIP."

Another possible policy intervention, the authors note, could be the expansion of partial assistance programs that help make private coverage more affordable for families who prefer coverage for everyone under one plan, an approach that would rely on the current private insurance market.

"When family members are covered separately under different plans or when certain individuals have coverage and others do not, children's health declines," researchers said. Over the long term, having both children and their parents covered under the same public insurance will be not only the most economic policy option, but also the most likely to provide stable coverage for children leading to better health outcomes for the nation's most vulnerable, they said.

"We know that two-thirds of children who are eligible for SCHIP are not enrolled in the program," said Bruce Lesley, president of First Focus, an advocacy organization for children and families. "This is an issue of outreach and enrollment, but it is not a substitute for national health reform."

The article is published as part of the Journal of the American Medical Association's "Health of the Nation" issue, a comprehensive overview of the heath policy–related debates, including state federal and state health care funding, tax changes as part of health care overhaul, and regulation of biotech drugs.

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