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In the past decade, political and economic changes in the United States (US) have affected health insurance coverage for children and their parents. Most likely these policies have differentially affected coverage patterns for children (versus parents) and for low-income (versus high-income) families. We aimed to examine--qualitatively and quantitatively--the impact of changing health insurance coverage on US families. Primary data from interviews with Oregon families (2008-2010) were analyzed using an iterative process. Qualitative findings guided quantitative analyses of secondary data from the nationally-representative Medical Expenditure Panel Survey (MEPS) (1998-2009); we used Joinpoint Regression to assess average annual percent changes (AAPC) in health insurance trends, examining child and parent status and type of coverage stratified by income. Interviewees reported that although children gained coverage, parents lost coverage. MEPS analyses confirmed this trend; the percentage of children uninsured all year decreased from 9.6% in 1998 to 6.1% in 2009; AAPC = -3.1% (95% confidence interval [CI] from -5.1 to -1.0), while the percentage of parents uninsured all year rose from 13.6% in 1998 to 17.1% in 2009, AAPC = 2.7% (95% CI 1.8-3.7). Low-income families experienced the most significant changes in coverage. Between 1998 and 2009, as US children gained health insurance, their parents lost coverage. Children's health is adversely affected when parents are uninsured. Investigation beyond children's coverage rates is needed to understand how health insurance policies and changing health insurance coverage trends are impacting children's health. Keywords Health insurance * Access to care * Health services research * Health policy * Health care disparities * Children's health care, Introduction In recent years, significant changes in children's health insurance coverage policies have occurred in the United States (US). The Children's Health Insurance Program (CHIP), established in 1997, increased federal [...]

Whether there is a relationship between insurance transitions and various policy and economic variables in the U.S. is investigated. It was found that national-level trends contributed to coverage dynamics from 1986 to 1999. Findings were found to indicate the need for more research to establish the relationship between increased insurance transitions and measures of child well-being.

The extent to which the State Children's Health Insurance Program (SCHIP) has achieved the goal plans set out for health care coverage is discussed. Further the continuing controversy over the applicable extent of health care coverage with the drawbacks and advantages is discussed.

The article discusses the reauthorization of the State Children's Health Insurance Program (SCHIP) that has been dragged in a larger struggle over ideologies that divide the political parties.

Possibility of state insurance for children being reactivated, the manifold advantages over private insurance for children are presented.

Objectives. Many county coalitions throughout California have created local health insurance programs known as Healthy Kids to cover uninsured children ineligible for public programs as a result of family income level or undocumented immigrant status. We sought to gain an understanding of the experiences of these coalitions as they pursue the goal of universal coverage for children. Methods. We conducted semistructured telephone-based or in-person interviews with coalition leaders from 28 counties or regions engaged in expansion activities. Results. Children's Health Initiative coalitions have emerged in 31 counties (17 are operational and 14 are planned) and have enrolled more than 85000 children in their health insurance program, Healthy Kids. Respondents attributed the success of these programs to strong leadership, diverse coalitions of stakeholders, and the generosity of local and statewide contributors. Because Healthy Kids programs face major sustainability challenges and difficulties with provider capacity, most are cautiously looking toward statewide legislative solutions. Conclusions. The expansion of Healthy Kids programs demonstrates the ability of local coalitions to reduce the number of uninsured children through local health reform. Such local programs may become important models as other states struggle with declines in employer-based coverage and increasing immigration and poverty rates. doi:10.2105/AJPH.2006.088690

The article examines the extent to which the nature of dental insurance possesed by American children determines their frequency of visits to dental care facilities and promotes preventive dental care usage.

Impact of family health insurance on the drop-out of children from Medicaid and other national health programs is examined.

The advantages of awarding reinsurance under State Children's Health Insurance Program, which enhances financial scenario of health plan groups, are presented.

This article describes a policy proposal of the 1960s for a program called fatherless child insurance. If enacted, the program would have expanded the New Deal social insurance tradition by bringing divorced and separated single mothers and their minor children, regardless of income, under the umbrella of Social Security protection. The political failure of the proposal provides some evidence to suggest that Frances Fox Piven and Richard Cloward were correct in claiming, in a defense of Aid to Families with Dependent Children program expansions of the 1960s, that it would be politically difficult to add universal programs.

Background. Lack of health insurance adversely affects children's health. Eight million US children are uninsured, with Latinos being the racial/ethnic group at greatest risk for being uninsured. A randomized, controlled trial comparing the effectiveness of various public insurance strategies for insuring uninsured children has never been conducted. Objective. To evaluate whether case managers are more effective than traditional methods in insuring uninsured Latino children. Design. Randomized, controlled trial conducted from May 2002 to August 2004. Setting and Participants. A total of 275 uninsured Latino children and their parents were recruited from urban community sites in Boston. Intervention. Uninsured children were assigned randomly to an intervention group with trained case managers or a control group that received traditional Medicaid and State Children's Health Insurance Program (SCHIP) outreach and enrollment. Case managers provided information on program eligibility, helped families complete insurance applications, acted as a family liaison with Medicaid/SCHIP, and assisted in maintaining coverage. Main Outcome Measures. Obtaining health insurance, coverage continuity, the time to obtain coverage, and parental satisfaction with the process of obtaining insurance for children were assessed. Subjects were contacted monthly for 1 year to monitor outcomes by a researcher blinded with respect to group assignment. Results. One hundred thirty-nine subjects were assigned randomly to the intervention group and 136 to the control group. Intervention group children were significantly more likely to obtain health insurance (96% vs 57%) and had ~8 times the adjusted odds (odds ratio: 7.78; 95% confidence interval: 5.20-11.64) of obtaining insurance. Seventy-eight percent of intervention group children were insured continuously, compared with 30% of control group children. Intervention group children obtained insurance significantly faster (mean: 87.5 vs 134.8 days), and their parents were significantly more satisfied with the process of obtaining insurance. Conclusions. Community-based case managers are more effective than traditional Medicaid/SCHIP outreach and enrollment in insuring uninsured Latino children. Case management may be a useful mechanism to reduce the number of uninsured children, especially among high-risk populations. Pediatrics 2005;116:1433-1441; insurance, Latino, Medicaid, medically uninsured, child health services, community health services. ABBREVIATIONS. CMSP, Children's Medical Security Plan; DMA, Division of Medical Assistance; DPH, Department of Public Health; SCHIP, State Children's Health Insurance Program., There were 8.4 million children without health insurance coverage in the United States in 2003, equivalent to 11.4% of children 0 to 17 years old. (1) Latino children have the [...]

A study of the influence of State Children's Health Insurance Program (SCHIP), on insurance coverage of children, using the Medical Expenditure Panel Survey between 1996 and 2002 data, is presented.

The factors affecting the effectiveness of State Children's Health Insurance Program or SCHIP are examined. It is noted that unique state programs have distinctive impact on the success of the program.

Objectives. We evaluated emergency department (ED)-based outreach for the State Children's Health Insurance Program (SCHIP). Methods. We conducted a multicenter trial among uninsured children ([less than or equal to] 18 years) who presented to 5 EDs in 2001 and 2002. On-site staff enrolled consecutive subjects for a control period followed by an intervention period during which staff handed out SCHIP applications to the uninsured. The primary outcome was state-level confirmation of insured status at 90 days. Results. We followed 223 subjects (108 control, 115 intervention) by both phone interview and state records. Compared to control subjects, those receiving a SCHIP application were more likely to have state health insurance at 90 days (42% vs 28%; P < .05; odds ratio [OR] = 3.8; 95% confidence interval [CI]= 1.7, 8.6). Although the intervention effect was prominent among 118 African Americans (50% insured after intervention vs 31% of controls, P < .05), lack of family enrollment in other public assistance programs was the primary predictor of intervention success (OR = 3.7; 95% CI = 1.6, 8.4). Conclusions. Handing out insurance applications in the ED can be an effective SCHIP enrollment strategy, particularly among minority children without connections to the social welfare system. Adopted nationwide, this simple strategy could initiate insurance coverage for more than a quarter million additional children each year. (Am J Public Health. 2005;95:250-253. doi: 10.2105/AJPH.2003.037242)

The effect of state children health insurance program (SCHIP) eligibility on public and private insurance coverage of children is estimated. The results show that about 9% of children meeting income eligibility standards enrolled in public insurance. This program is considered favorable for low income families.

The impact of having an uninsured parent on access and utilization of health care for low-income children is investigated.

Many managed care companies do not provide the same services to children covered by Medicaid as they do to children covered by private health insurance. This was the conclusion of researchers who compared 423 commercial and 169 Medicaid managed care plans using the Health Plan Employer Data and Information Set (HEDIS). Children covered by Medicaid were less likely to be vaccinated, to have regular well-child visits and to receive procedures such as ventilation tubes for ear infections.

Objectives. Emergency department (ED) overcrowding has become a national problem. Children account for nearly 25% of overall ED visits. It has been reported that uninsured and publicly insured children are likely to visit the ED for urgent and nonurgent problems, yet it remains unclear to what extent health insurance status would influence children&apos;s overall ED utilization or ED utilization for nonurgent problems at the national level after controlling for other confounding factors. The objective of this study was to examine the effect of health insurance status on children&apos;s overall ED utilization and children&apos;s ED utilization for nonurgent problems among the general pediatric population in the United States. Methods. Secondary analysis of the household component of the 1997 Medical Expenditure Panel Survey on 10 193 children younger than 18 years. The main outcome measures were annual overall ED utilization and ED utilization for nonurgent problems. Results. During 1997, 10.8% of children were uninsured for the entire year. A total of 17.5% of children were publicly insured the entire year, whereas 55.3% of children held private insurance the entire year. There were also 16.5% of children who were insured only part of the year. Without adjusting for covariates, publicly insured children were more likely to have an ED visit during the year than both privately insured children (unadjusted odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.03-1.55) and uninsured children (unadjusted OR: 1.46; 95% CI: 1.1-1.95). The difference between publicly insured and privately insured children (adjusted OR: 0.90; 95% CI: 0.70-1.16) and between publicly insured and uninsured children (adjusted OR: 1.12; 95% CI: 0.84-1.49) became insignificant after controlling for covariates. With or without adjustments for covariates, there was no significant difference in the likelihood of having an ED visit between privately insured and uninsured children. Similar to the utilization pattern of overall ED visits, publicly insured children were more likely to have a nonurgent ED visit than both privately insured (unadjusted OR: 1.86; 95% CI: 1.36-2.53) and uninsured children (unadjusted OR: 1.81; 95% CI: 1.15-2.84). Both differences disappeared after controlling for covariates. There was no significant difference in the likelihood of nonurgent ED visits between privately insured and uninsured children with or without adjustments for covariates. Conclusions. Health insurance status was not associated with children&apos;s overall ED use or children&apos;s ED use for nonurgent problems at the national level. Our findings suggest that policy efforts in an attempt to relieve ED overcrowding conditions should look for measures beyond solely making changes in health insurance coverage for children. emergency, nonurgent, insurance, children, utilization., ABBREVIATIONS. ED, emergency department; HMO, health maintenance organization; MEPS, Medical Expenditure Panel Survey; OR, odds ratio; CI, confidence interval. Health insurance status has a profound impact on children s access [...]

Byline: Donna J. Petersen (1), Janet Bronstein (2), Mary Ann Pass (1) Keywords: medical home; Medicaid; children; Title V; information systems Abstract: Objectives: In light of the transition of the Alabama Medicaid program to a primary care case management model, we assessed the level to which children had access to a medical home before and after implementation of that model. Given the growing emphasis within the MCH community on assuring children medical homes, we explored whether Medicaid claims data could be used to assess medical home coverage. Methods: We operationally defined "medical home" as use of a single primary care physician combined with receipt of at least one well child visit from that physician during the year. Using Alabama Medicaid claims data we assessed whether children&apos;s receipt of health care services met this defintion, the extent to which Medicaid-enrolled children had primary care providers and received well child visits, and changes in the source of well child visits before and after implementation of a primary care case management model in 26 of Alabama&apos;s 67 counties. Results: In general, Medicaid-enrolled children in Alabama did not meet our definition of medical home either before or after implementation of a primary care case management model. Only 11.8% of children saw a single provider and had a well child visit from that provider during the baseline year. A majority of children (49.9%) however had both a primary care provider and received a well child visit. Sixteen percent of children saw a primary care physician but received no identifiable well visit, while 11% had well child care but did not see a primary care physician. Of particular concern, 23% neither saw a primary care physician nor had a well child visit during the baseline year. These figures changed only slightly in the 26 counties examined before and after implementation of the primary care case management model. Conclusions: State Maternal and Child Health programs are required to report as a performance measure "the percent of children with special health care needs in the state who have a medical/health home" as part of their Block Grant application. Using Medicaid data, this simple measurement strategy can provide an indication of the extent to which at least one population of children receive care through a medical home. Author Affiliation: (1) Department of Maternal and Child Health, School of Public Health, University of Alabama, Birmingham, Alabama (2) Department of Health Care Organization and Policy, School of Public Health, University of Alabama, Birmingham, Alabama Article History: Registration Date: 05/10/2004

Data from the National Survey of America's Families from 1997 found that there is a major difference in medical care use and access by children on Medicaid. The reasons for these differences are not completely clear.

Medicaid coverage will not necessarily ensure that children will get the dental care they need. According to data from the 1996 Medical Expenditure Panel Survey, 56% of children with private insurance made at least one visit to a dentist that year, but only 28% of children covered by Medicaid visited a dentist.

The expansion of Medicaid coverage for children did not come as a result of removal from private health insurance coverage. This expansion just ensured that more children received health insurance.

The State Children's Health Insurance Program is expected to have economic and coverage ramifications. These ramifications are discussed.

A 23% increase in the Medicaid coverage of children after changes made during the early 1990s was due to families selecting this coverage because they were eligible for it but would have been covered by private insurance if the rules had not changed. This result shows that private insurance was not displaced by Medicaid.

Many insurance companies will not cover growth hormone therapy even though a physician may recommend it. Researchers surveyed 1,504 primary care physicians, 534 pediatric endocrinologists and 113 several different insurers, including HMOs. Physicians recommended growth hormone therapy for 78% of children with growth hormone deficiency, Turner syndrome, or kidney failure. However, 28% would have been denied coverage by their insurance plan. Most insurance plans would not cover growth hormone therapy for short stature., Context.--There is concern in both the medical community and the general public about mechanisms of medical decision making and the interplay of physician and insurer decisions in determining access to care. Objective.--To examine the medical process influencing access to growth hormone (GH) therapy for childhood short stature by comparing coverage policies of US insurers with the treatment recommendations of US physicians. Design and Participants.--Independent national representative surveys were mailed to insurers (private, Blue Cross/Blue Shield, health maintenance organizations, programs for Children with Special Health Care Needs, and Medicaid programs, n=113), primary care physicians (n=1504), and pediatric endocrinologists (n=534) with response rates of 75%, 60%, and 81%, respectively. Each survey included identical case scenarios. Primary care physicians were asked decisions about referrals to pediatric endocrinologists. Endocrinologists were asked GH treatment recommendations. Insurers were asked coverage decisions for GH therapy. Main Outcome Measures.--Insurer coverage decisions for GH in specific case scenarios were compared with the recommendations of primary care physicians and pediatric endocrinologists. Results.--Physician recommendations and insurance coverage decisions differed strikingly. For example, while 96% of pediatric endocrinologists recommended GH therapy for children with Turner syndrome, insurer policies covered GH therapy for only 52% of these children. Overall, referral and treatment decisions by physicians resulted in recommendations for GH therapy in 78% of children with GH deficiency, Turner syndrome, or renal failure; of those recommended for treatment, 28% were denied coverage by insurers. Similarly, GH therapy would be recommended by physicians for only 9% of children with idiopathic short stature, but insurers would not cover GH for the vast majority of these children. Furthermore, the data indicated considerable variation among insurers regarding coverage policies for GH (P [is less than] .01). Conclusions.--Access to GH therapy differs depending on the type of insurance coverage. The deep discord between physician recommendations and insurance coverage decisions, exemplified by these findings, represents a major challenge to mechanisms of health care decision making, access, and costs. JAMA. 1998;279:663-668

Children who are not insured may have poor access to primary care. Researchers evaluated data from the 1993-1994 National Health Interview Survey, which included 49,367 children under 18 years old. Based on this data, an estimated 13% of all American children were uninsured during 1993-1994. Uninsured children were less likely to have a regular primary care physician, access to medical care after hours, and more likely to have gone without needed medical or dental care. Their families were more likely to be dissatisfied with their care.

Physicians who care for uninsured children are likely to refer them to a free vaccination clinic, which could result in a delay in vaccination. A survey of 1,236 family physicians, general practitioners and pediatricians revealed that 58% used the child's insurance status to decide whether to vaccinate them or send them to a clinic. Physicians who received free vaccines from the Vaccines for Children program were much less likely to refer the child to a clinic than physicians who did not receive free vaccines. This program was set up specifically to provide free vaccination to those unable to afford it., Context. -- Concerns about financial barriers to vaccination led to the development of the Vaccines for Children (VFC) program, which provides free vaccines to states for children who are uninsured, Medicaid eligible, or Native American or Native Alaskan. Objective. -- To understand the effect of economic factors on physician likelihood of referring children to public vaccine clinics for immunizations and to evaluate the VFC program. Design. -- A standardized survey was conducted in 1995 by trained personnel using computer-assisted telephone interviewing. Setting and Participants. -- A stratified random sample of family physicians, pediatricians, and general practitioners younger than 65 years who were in office-based practices across the United States. Main Outcome Measures. -- Likelihood of referral of a child to a health department for vaccination by child&apos;s insurance status and by the physician&apos;s receipt of free vaccines. Results. -- Of the 1769 physicians with whom an interviewer spoke, 1236 participated. Most respondents (66%) were likely to refer an uninsured child to the health department for vaccination, whereas only 8% were likely to refer a child who had insurance that covers vaccination. The majority (58%) of physicians reported differential referral based on insurance status. Among physicians who received free vaccine supplies from the VFC program or elsewhere, 44% were likely to refer an uninsured child whereas 90% of those not receiving free vaccine were likely to refer the same child (P [is less than] .001). In regression analysis, the receipt of free vaccine supplies accounted for 24% of the variance in the likelihood to refer an uninsured child for vaccination. Conclusions. -- Physicians receiving free vaccine supplies report being less likely to refer children to public clinics for vaccinations.

Children whose families live below the poverty level should be guaranteed Medicaid coverage even if Congress and the Administration place caps on Medicaid spending. Medicaid is an important safety net for children since it covers them when a parent loses private health insurance. Medicaid also provides preventive care to poor children whose parents could not otherwise afford it. Many of these parents have minimum wage jobs and cannot afford to pay for private health insurance. Reducing Medicaid expenditures may make it difficult for many families to move off of welfare. Poor children often have higher rates of acute and chronic illness. Children and their families accounted for only 27% of Medicaid expenditures in 1993, an amount that comes to 1% of the total federal budget. Health care expenditures for children accounted for only 20% of Medicaid growth between 1988 and 1993. Any cuts in Medicaid should be applied proportionately across all groups.

The factors that deprived children of health insurance between 1992 and 1993 are studied. Results show that children under 18 accounted for 922,500 of the 1.1 million increase in uninsured individuals. Children often remained uninsured despite expanded Medicaid coverage due to impediments to enrollment such as language barriers' and their parents' lack awareness about Medicaid eligibility. Children in families with incomes of more than 200% of the poverty level are also expected to become uninsured between 1992 to 1993.