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Parents' Report of Their Children's Underinsurance Status After the Affordable Care Act
John M Pascoe1, Adrienne Stolfi1, Gregory Eberhart1
1From the Department of Pediatrics, Wright State University-Boonshoft School of Medicine, Dayton, OH.
Insights
Approximately 1 in 6 children were underinsured, a rate unaffected by the Affordable Care Act (ACA). Low income and poor child health were key factors associated with underinsurance, impacting children's access to needed healthcare.
Area of Science:
- Pediatrics
- Health Services Research
- Public Health
Background:
- Underinsurance in children poses a significant barrier to accessing necessary healthcare services.
- The Affordable Care Act (ACA) aimed to expand health insurance coverage, but its impact on child underinsurance requires examination.
Purpose of the Study:
- To determine the prevalence and correlates of children's underinsurance before and after the implementation of the Affordable Care Act (ACA).
Main Methods:
- A cross-sectional survey of 5043 parents of children aged over 6 months was conducted.
- Data were collected pre-ACA (2009-2011) and post-ACA (2016) using the Medical Expenses for Children Survey.
- Statistical analyses adjusted for demographic factors to identify correlates of underinsurance.
Main Results:
- Approximately 1 in 6 children in the study were underinsured.
- The Affordable Care Act (ACA) did not significantly alter the underinsurance rate.
- Factors significantly associated with underinsurance included annual household income below $50,000 and poor child health.
Conclusions:
- Child underinsurance remains a persistent issue, with approximately one-third of parents reporting negative impacts on their child's health due to affordability.
- The ACA did not reduce the prevalence of underinsurance in this population.
- Efforts to address child underinsurance must consider socioeconomic factors and child health status.
Objective:
To determine the prevalence and correlates of children's underinsurance pre- and post-implementation of the Affordable Care Act (ACA).
Study Design:
A cross-sectional survey of a convenience sample of 5043 parents of children greater than 6 months old who had health insurance in the previous 12 months. Respondents completed the Medical Expenses for Children Survey. Pre-ACA data were collected in summer/fall of 2009 to 2011 (n = 3966); post-ACA data were collected in summer/fall 2016 (n = 1077). All data were collected within the Southwestern Ohio Ambulatory Research Network (SOAR-Net).
Results:
Some study parents (16.3%) were unable to follow at least 1 recommendation of their child's pediatrician due to their inability to pay for it, and 17.3% reported it had become more difficult to obtain "needed health care" in the past 3 years. Factors associated with underinsurance after adjusting for demographic factors did NOT include pre/post-ACA, but did include annual household income < $50,000 (adjusted odds ratio [AOR] = 2.71; 95% CI, 2.15-3.40). Poor child health was also a significant risk factor for underinsurance(AOR = 3.71; 95% CI, 2.61-5.29).
Conclusions:
About 1 in 6 study children were underinsured. The ACA did not affect the underinsurance rate. Parents continued to report that it had become more difficult to obtain needed health care over the past 3 years post-ACA. About one third of study parents consistently reported that the health of their underinsured child had suffered because they could not afford to pay for their child's health care.
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