July 25, 2001
INSURING PARENTS HELPS CHILDREN: A FACT SHEET
The idea that expanding health insurance coverage to low-income parents also helps their children gain coverage was stressed by then-governors Tommy Thompson of Wisconsin and Christine Todd Whitman of New Jersey when they announced their states' initiatives to expand coverage for low-income parents whose children are eligible for Medicaid or the State Children's Health Insurance Program (SCHIP). In addition, Gary Stangler, the human services commissioner in Missouri under governors Ashcroft and Carnahan, noted that after his state expanded parents' eligibility, "With no outreach, no advertising, no partnerships to spread the word, enrollment soared....Helping adults greatly contributed to the enrollment of children."(1)
This brief fact sheet reviews the compelling evidence that expanding coverage to low-income parents so all members of the family can be covered under the same program, can help more children gain coverage and help them use health services more effectively. Expanding coverage for low-income parents, thus, would build upon the successes and strengths of state and federal child health initiatives.
Insuring Parents Increases Children's Coverage
Since the enactment of SCHIP in 1997, every state has expanded child health insurance coverage. Most states now offer coverage to low-income children living in families whose incomes are less than twice the poverty level ($29,260 per year for a family of three). However, about seven million children who are eligible for SCHIP or Medicaid were uninsured in 1999, the last year for which Census data are available; these children make up about 95 percent of all low-income uninsured children.(2) Expanding coverage for parents can facilitate enrollment of these eligible but uninsured children, because the whole family can apply for coverage together in the same plan.
- In general, when parents are insured, their children are insured as well. Over 90 percent of the low-income children with insured parents are themselves insured. By contrast, fewer than half (48 percent) of the children with uninsured parents have coverage.(3)
- Research has found that when states broaden eligibility for parents, more eligible children gain coverage. A recent Urban Institute study found that the proportion of low-income children who were eligible for Medicaid but uninsured was about half as large in states that have broadened Medicaid coverage for low-income parents as in states without such expansions.(4)
- A Center on Budget and Policy Priorities analysis demonstrated that the proportion of eligible children who participated in Medicaid rose faster in states that implemented expansions that covered parents than in states that did not. Young children's participation rates increased from 51 to 67 percent after the states implemented family-based expansions, while changing from 51 to 54 percent in states without such expansions.(5)
Children with Insured Parents Use Health Services More Effectively
In addition to stimulating greater insurance coverage among children, insuring parents can improve their children's use of health services. When parents have seen a doctor, their children are two or three times more likely to see one, too.(6) This may reflect the fact that it is easier to use health services when the whole family is covered under the same health plan and can use the same providers.
- A new study from Pennsylvania State University assessed how insurance coverage affects low-income children's use of preventive health services. The use of well-child visits, which are recommended by the American Academy of Pediatrics, was highest when both children and parents were enrolled in Medicaid. Children in such families used preventive care more than low-income children with other combinations of insurance coverage, including situations where both children and parents had private coverage, where the children had Medicaid but the parents were uninsured, and where the children were uninsured.(7)
- Evaluations of state expansions that covered parents and children alike have documented impressive improvements in health care access for adults and children, such as increases in the use of preventive and primary care services like Pap smears for women and well-child visits for children. Those who gained insurance coverage were better able to obtain medical care when they needed it and were more satisfied with their health care than comparable adults and children who were uninsured.(8)
1. Comment by Gary Stangler on "Supporting Work Through Medicaid and Food Stamps," by Bob Greenstein and Jocelyn Guyer in Rebecca Blank and Ron Haskins, editors, The New World of Welfare, Washington, DC, Brookings Institution, forthcoming.
2. Matthew Broaddus and Leighton Ku, "Nearly 95 Percent of Low-income Uninsured Children Now Are Eligible for Medicaid or SCHIP," Center on Budget and Policy Priorities, Dec. 6, 2000.
3. Jeanne Lambrew, "Health Insurance: A Family Affair," Commonwealth Fund, May 2001.
4. Lisa Dubay and Genevieve Kenney, "The Effects of Family Coverage on Children's Health Insurance Coverage," Urban Institute, presentation at the Academy for Health Services Research and Health Policy Conference, Atlanta, June 12, 2001.
5. Leighton Ku and Matthew Broaddus, "The Importance of Family-Based Insurance Expansions:
New Research Findings about State Health Reforms," Center on Budget and Policy Priorities, Sept. 5, 2000.
6. Karla Hansen, "Is Insurance Enough? The Link Between Parents' and Children's Health Care Use," Inquiry, 35(3):294-302, 1998.
7. Elizabeth Gifford, Robert Weech-Maldonado and Pamela Farley Short, "Encouraging Preventive Health Services for Young Children: The Effect of Expanding Coverage to Parents," Pennsylvania State Univ., presentation at the Academy for Health Services Research and Health Policy Conference, Atlanta, June 12, 2001.
8. Lorenzo Moreno and Sheila Hoag, "Covering the Uninsured Through TennCare: Does It Make a Difference?" Health Affairs, 20(1):231-39, Jan/Feb. 2001. Lorenzo Moreno and Cheri Vogel, "The Effects of Insurance Expansions for Adults and Children: The Hawaii Experience," Mathematica Policy Research, April 27, 2001.