Parents’ lack of health insurance coverage and access to health services can reduce children’s access to care and harm their families’ broader financial health. This is why the Urban Institute’s new report on coverage, access, overall health, and ability to meet family financial needs among parents at different income levels after the first year of the pandemic raises such serious concerns.

Parents with Low Incomes Faced Greater Health Challenges and Problems Accessing and Affording Needed Health Care in Spring 2021, Urban Institute

The Urban Institute’s Health Reform Monitoring Survey has been a critical source of data throughout the pandemic as Census Bureau, administrative, and other large survey datasets have experienced pandemic-related data quality issues. First fielded in 2013, the survey was adapted in 2020 to begin collecting information on the pandemic and has continued to provide timely snapshots of families’ pandemic experiences. This report presents findings from the April 2021 round of the survey, focusing on parents of children under age 19 with low incomes (138% of the federal poverty line or lower), moderate incomes (139-399% of the federal poverty line), and higher incomes (400% of the federal poverty line or higher).

What They Find:

Compared to higher-income parents, low-income parents were:

• More likely to have younger children under age 6 (51.0% for low-income vs. 36.4% for higher income)
• Nine times more likely to be uninsured (21.0% vs. 2.3%). Moderate-income parents were five times more likely to be uninsured (12.1%)
• More likely to report greater health needs. More than 1 in 4 (26.4%) reported that they were in fair or poor health, nearly half (48.3%) reported a chronic condition, and 1 in 4 (40.9%) reported a behavioral or mental health condition. Just 3.9, 34.8, and 20.0 percent of higher-income parents said the same
• Three times more likely to have delayed or forgone care in the past year (61.5% vs. 18.8%), either because of cost concerns, difficulties getting time off from work or family responsibilities, or difficulties with transportation. Additionally, low-income parents were less likely to have a usual source of care compared to higher-income parents (76.4% vs. 84.7%)
• Seven times more likely to report trouble paying medical bills in the past year (29.7% vs. 4.2%). They were also more likely to be worried about paying debt (49.4% vs. 7.4%); gas, oil, or electricity bills (45.5% vs. 4.3%); or rent or mortgage (41.4% vs. 4.3%); and more than 1 in 3 were worried about having enough to eat (33.0% vs. 2.5%)

Why it Matters:

• These income disparities intersect with inequities along racial, linguistic, geographic, and other demographic and socioeconomic lines. Compared to higher-income parents, low-income parents in this survey were more likely to be Black or Hispanic/Latinx to speak Spanish, and to live in the South or in a non-metro area, and less likely to have attended college or be married.
• Low-income parents under 138 percent of the federal poverty line are eligible for Medicaid coverage in states that expanded eligibility under the Affordable Care Act. The Families First Coronavirus Response Act’s continuous eligibility requirement has also meant that states cannot disenroll anyone who was already enrolled or enrolled after March 18, 2020 through the duration of the COVID-19 public health emergency. However, those who fall into the coverage gap in non-expansion states or who don’t have a qualifying immigration status may lack another pathway to affordable coverage.
• Parents who have health insurance are more likely to sign their children up for coverage and less likely to experience economic hardships, and parents who receive needed treatment are better able to care for their children. Improving low-income parents’ coverage and access to health care is critically important to supporting healthy kids.