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Health Insurance Coverage Gaps Among Children With a History of Adversity

Chidiogo Anyigbo1,2, Emmalee Todd3, Dmitry Tumin3

  • 1Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Medical Care Research and Review : MCRR
|June 17, 2023
PubMed

Insights

Children with more adverse childhood experiences (ACEs) face greater health insurance instability. Higher ACE scores increase the risk of coverage gaps, often due to application issues, impacting healthcare access.

Area of Science:

  • Child Health
  • Health Services Research
  • Social Determinants of Health

Background:

  • Health insurance stability is crucial for children's healthcare access.
  • Adverse Childhood Experiences (ACEs) are linked to various negative health outcomes.
  • Understanding the impact of ACEs on insurance continuity is vital for targeted interventions.

Purpose of the Study:

  • To examine the association between ACE scores and health insurance stability in children aged 0-17.
  • To identify reasons for health insurance coverage gaps among children with ACEs.
  • To inform policy recommendations for improving insurance access for vulnerable children.

Main Methods:

  • Cross-sectional study utilizing a nationally representative, multi-year database.
  • Analysis of the association between ACE scores and continuous/intermittent lack of health insurance over 12 months.
  • Investigation of reported reasons for insurance coverage gaps.

Main Results:

  • Children with 4+ ACEs were significantly more likely to experience part-year uninsurance compared to those with 0 ACEs (RRR: 4.20).
  • Higher ACE scores correlated with increased likelihood of year-round uninsurance (RRR: 2.28) and part-year public insurance (RRR: 1.37).
  • Difficulties with application or renewal processes were more frequently cited as reasons for coverage gaps among children with higher ACE scores.

Conclusions:

  • Adverse Childhood Experiences significantly disrupt health insurance stability in children.
  • Policy interventions addressing administrative burdens in insurance application/renewal may enhance access for children with ACEs.
  • Improving insurance continuity is essential for ensuring consistent healthcare services for children exposed to adversity.

Keywords:
administrative burdenadverse childhood experiencechild healthhealth insurance coverage

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