Accurately estimating the number of children without access to healthcare

Knowing the extent to which children lack healthcare access is essential to health reform. Child healthcare access has generally been measured by the percent and number of children without health insurance for a full year. This is only a partial estimate of the problem. To accurately determine the number of children without adequate healthcare access, we ascertained the inconsistencies and inaccuracies of federal data sources commonly used to estimate uninsured children (MEPS, CPS, NHIS); applied an existing methodology to include partial-year uninsured children; and used original data to estimate the percent and number of children without transportation access to healthcare. We found that federal estimates of uninsured children are limited by sampling bias inherent in survey methodologies including an arbitrary upper age limit (e.g., 17 or 18 years) which understates the percent and number of uninsured youth. Including children with interrupted coverage who are uninsured for part of the year more than doubles the number of children for whom insurance is a barrier to access. The percentage of children who are inadequately insured (e.g., covered for catastrophic illness but not routine and preventive care) is difficult to estimate. An estimated 4% of children nationwide do not have transportation access to healthcare regardless of their insurance status, a problem which especially affects children in health professional shortage areas. When appropriately calculated, the number of children with significant economic and non-economic barriers to healthcare access increases from approximately 8.1 million (full-year uninsured) to more than 20 million children.