Kids with Gaps in Coverage Have Less Access to Care

Last week, we blogged about the 1 in 10 children who were uninsured at some point during the course of the recent uptick in uninsured children and how requiring 12-month continuous eligibility in both Medicaid and CHIP could help reduce racial, income, and geographic disparities in kids’ insurance coverage. This week, we’re taking another look at what this new data show about how unstable coverage can hurt kids’— and their families’— ability to access, use, and afford health care.1

As the chart below shows, children who were uninsured over the course of a year face more barriers to care compared to children who were covered year-round.

More than 1 in 4 kids (26%) with a gap in coverage did not have a usual source of care. A usual source of care is a point of contact with the health system, somewhere a child can reliably go if they get sick, or need a flu shot, or a recommendation for specialty care. Not having that means that kids could have less access to doctors and treatment, and kids who were uninsured during the year were more than three times as likely as insured kids to not have a usual source of care.

About half (50%) of kids with a gap in coverage did not see a physician during the year. Regular well-baby and well-child visits help make sure that kids are growing and developing as they should, and the immunizations and developmental and nutritional screenings that often take place in a doctor’s office are important measures of quality of care. While a plurality of kids (43%) who had health coverage for the entire year saw a doctor at least twice, most kids who had a period of uninsurance didn’t get a single visit.

While the number of emergency room visits were mostly similar, kids who were uninsured during the year were slightly less likely to have two or more emergency visits than kids with year-round coverage, at about 1 percent compared to 2 percent.

Nearly 1 in 4 kids (23%) who were ever uninsured were in families that had trouble affording their health care, more than twice the share of families whose kids didn’t have a gap in coverage (11%). This could include not receiving treatment because they couldn’t afford it, delaying treatment because of cost, or living in a family with someone who had problems paying or was unable to pay their medical bills. This may come as little surprise, given that lower-income kids are more likely to be uninsured during the year, but it highlights the important role insurance plays in financially protecting families.

Despite these issues, families of kids who were ever uninsured weren’t more likely to report that they were in fair or poor health, but they also weren’t as likely as kids with year-round coverage to be in excellent or very good health, at about 81 percent compared to 84 percent.

As we’ve blogged about before, the House reconciliation package includes a provision that would require states to provide 12-month continuous eligibility for kids in both Medicaid and CHIP. Currently, only 24 states have continuous eligibility for Medicaid and 26 have it for CHIP. Negotiations are underway about the final contours of the bill. We’ve said it before but it bears repeating: mandating continuous eligibility is one of the best ways Congress can bolster kids’ coverage, improve measurement of the quality of care in Medicaid and CHIP, and advance health equity.

  1. Georgetown University Center for Children and Families analysis of Agency for Healthcare Research and Quality’s 2018-2019 Medical Expenditure Panel Survey data. Sample includes children under age 19 who had health insurance data reported for all twelve months. Children are considered to be uninsured during the year if they were uninsured in at least one month.