Trends in type of insurance coverage for US children, 2003-2012

Background:  Research has found increasing instability in health insurance coverage for children, and a possible shift from private to public insurance since 2000. Children receiving public health insurance may have less access to needed providers and be less likely to have a medical home.  This nationally-representative study investigates temporal changes in insurance coverage type from 2003 to 2011-2012.

Methods: We compared the 2003 and 2011-2012 National Surveys of Children's Health, representing 102,353 and 94,500 children, aged 0-17, respectively.  Bivariate and multivariable analyses identified changes between 2003 and 2011-2012, by sociodemographic characteristics and health-related factors, including presence of special health care needs (SHCN). 

Results: US children with public insurance increased from 27.7% to 37.1%, while there were declines in the proportion with private insurance (63.7% to 56.9%), and those uninsured (8.8% to 5.6%).  Public coverage was more commonly reported for children in poor health (58% in 2003, 69% in 2011-2012), or having a SHCN (34% in 2003, 44% in 2011-2012). Public coverage increased for all children, but particularly for Hispanic children.  Private coverage declined among children living in poor and near-poor families (≤200% FPL) while public coverage increased for those in households with incomes between >200 - ≤400% FPL.  Comparing 2011-2012 to 2003, adjusted relative risks for type of insurance were 1.23 (public), .95 (private), and .60 (uninsured). 

Conclusions: Understanding changes in pediatric insurance coverage, particularly for the most vulnerable children, is needed to anticipate future demands on service providers, payers, and families as the Affordable Care Act is fully implemented.