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Rising Underinsurance in Children

February 4, 2022

Summary: National child health survey data reveal that underinsurance (lack of continuous and adequate insurance) rose from 31% in 2016 to 34% in 2019 — a jump of 2.4 million children. Underinsurance is associated with having private insurance and health complexity. Our failing private insurance system keeps getting worse.

Underinsurance Among Children in the United States
January 2022
By Justin Yu et al.


We describe the change in the percentage of children lacking continuous and adequate health insurance (underinsurance) from 2016 to 2019. We also examine the relationships between child health complexity and insurance type with underinsurance.


Analysis of the National Survey of Children’s Health


From 2016 to 2019, the proportion of US children experiencing underinsurance rose from 30.6% to 34.0%, an additional 2.4 million children. This trend was driven by rising insurance inadequacy (24.8% to 27.9%), which was mainly experienced as unreasonable out-of-pocket medical expenses. We observed significant growth in underinsurance among White and multiracial children, children living in households with income ≥200% of the federal poverty limit, and those with private health insurance. Increased child health complexity and private insurance were significantly associated with experiencing underinsurance.


Underinsurance is increasing among US children because of rising inadequacy. Reforms to the child health insurance system are necessary to curb this problem.

What’s Known on This Subject:

Continuous and adequate health insurance is critical to child health. In recent years, child uninsurance has increased, and participation in Medicaid and the Children’s Health Insurance Program has fallen. Research examining whether these trends also apply to child underinsurance is needed.

What This Study Adds:

From 2016 to 2019, underinsurance rose significantly among US children because of increased rates of insurance inadequacy. Increased health complexity and private insurance were associated with being underinsured. Notably, underinsurance grew significantly among White children living in middle-income families.

Comment by: Don McCanne

We are certainly aware of how dysfunctional our health care financing system is. With children, we tend to think that it is primarily low-income and racial minority children who are underinsured. This study shows that white children living in middle-income families were also exposed to significant growth in underinsurance. Increased health complexity and having private insurance were associated with being underinsured.

It is not only the poor and oppressed amongst us that need a better and more just health care financing system. We all do. With a truly universal, publicly administered and equitably financed health care system, we would all do well, certainly including the children. If the social welfare of all of our children can’t motivate Congress and the President to do the right thing, then what can?

© Health Justice Monitor
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