Why Eligible Children are Uninsured

HEALTH INSURANCE

Case 18.2: Children’s Health Insurance

Why are children who are eligible for free coverage uninsured?

In 1997, the United States (US) created the State’s Children Health Insurance Program (SCHIP), which allowed states to expand public coverage to children from low-income households (Kenney & Haley, 2001). The expansion made coverage available for all uninsured children (Kenney & Haley, 2001). However, a large number of children still remain uninsured. A study by the Urban Institute sought to find out the possible reasons for this (Kenney & Haley, 2001). Following interviews with parents of uninsured children, the study found two main reasons for this trend: knowledge gaps and administrative hassles (Kenney & Haley, 2001).

Knowledge gaps arose from parents’ lack of knowledge about the program’s availability and their children’s eligibility. Between 29 and 30 percent of the parents interviewed reported that they did not apply for coverage because they did not think their child was eligible (Kenney & Haley, 2001). A majority of the parents, for instance, thought that their child was ineligible because of the parents’ car ownership or citizenship status, and the family income level (Kenney & Haley, 2001). Of those who had enough information about eligibility, 3 to 4 percent reported that they lacked information about the program (Kenney & Haley, 2001). For instance, they did not know that the program was available in their state or where to find more information about the requirements (Kenney & Haley, 2001). Approximately 40 percent of parents also failed to enrol their children because they considered the free coverage a government hand out and did not want to be a part of it, while others felt that coverage was unnecessary as the child was receiving needed care from community health centers (Kenney & Haley, 2001).

The study results show that approximately 38 percent of parents have sufficient information but fail to enrol their children because of the administrative hassles involved (Kenney & Haley, 2001). For instance, parents reported that they failed to enrol their children because of their inability to communicate in English, transportation barriers, time limitations, and lack of necessary documents (Kenney & Haley, 2001). Lee (2019) points out that parents are less likely to enrol their children if they believe that the hassles involved outweigh the expected benefits. Parents’ immigration status also emerged as a barrier to children’s insurance coverage. Some parents opted to not enrol their children for coverage because they felt that it would expose their undocumented status to the authorities (Kenney & Haley, 2001).

Another study found that a parent’s decision to obtain coverage for their child depended on whether they had coverage themselves (DeVoe et al., 2008). DeVoe et al. (2008) found that uninsured parents were less likely to insure their children because they did not consider insurance necessary. As such, the authors recommend that one way to increase coverage for children is by extending the free insurance coverage to parents (DeVoe et al., 2008).

How could the health insurance be simplified overall?

States could use different strategies to simplify the process of obtaining public coverage for their children. For instance, Lee (2019) mentions that the process could be simplified by integrating systems such that eligibility for one program, such as the Supplemental Nutrition Assistance Program, automatically makes one eligible for public insurance coverage. This would reduce the time one has to spend filling out documentations for several public programs. Further, states could grant eligibility that takes longer to expire and eliminate non-core processes such as face to face interviews as these may discourage a good number of parents (Lee, 2019). In light of the growing use of mobile devices, states could also simplify the application procedures by developing mobile apps that allow parents to apply for coverage at the touch of a button (Lee, 2019). Other ways to simplify insurance procedures include permitting self-verification of household incomes, allowing parents to mail in their applications, and streamlining redetermination processes (Kenney & Haley, 2001).