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America's Children: Key National Indicators of Well-Being, 2021

Health Insurance Coverage

Health insurance is a major determinant of access to healthcare.41 Children and adolescents need regular and ongoing health care to treat acute and chronic conditions and provide injury care and routine preventative care, including vaccinations.42 Children with health insurance, whether public or private, are more likely than children without insurance to have a regular and accessible source of healthcare (see HC2). Children may be eligible for health insurance through private coverage or public programs such as Medicaid, enacted in 1966, and the Children's Health Insurance Program, started in 1997.43, 44 The percentage of children who have health insurance is one indicator of the extent to which families can obtain preventive care or healthcare for a sick or injured child.45

Indicator HC1: Percentage of children ages 0–17 by health insurance coverage status at the time of interview, 2009–2019
Indicator HC1: Percentage of children ages 0–17 by health insurance coverage status at the time of interview, 2009–2019

NOTE: A child was considered uninsured if he or she did not have any private health insurance, Medicare, Medicaid, Children's Health Insurance Program (CHIP), a state-sponsored or other government-sponsored health plan, or a military plan. A child also was defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service, such as accidents or dental care. Private health insurance includes children covered by any comprehensive private insurance plan (including health maintenance organizations and preferred provider organizations). These plans include those obtained through an employer, purchased directly, purchased through local or community programs, or purchased through the Health Insurance Marketplace or a state-based exchange. Public health insurance includes children who do not have private coverage but who have Medicaid or other state-sponsored health plans, including CHIP. In 2019, the National Health Interview Survey (NHIS) questionnaire was redesigned, and other changes were made to weighting and design methodology. Therefore, data for 2019 are not strictly comparable with data for earlier years. For more information on the 2019 NHIS redesign, see https://www.cdc.gov/nchs/data/nhis/earlyrelease/EReval202009-508.pdf.

SOURCE: National Center for Health Statistics, National Health Interview Survey.

  • The percentage of children ages 0–17 without health insurance at the time of interview decreased from 8% in 2009 to 5% in 2015 and then remained stable through 2018. In 2019, 5% of children lacked health insurance.
  • The percentage of children with private coverage was stable from 2009 to 2012 (53% in 2012) and then increased through 2018 to 55%. In 2019, 56% of children had private coverage.
  • The percentage of children with public coverage increased from 33% in 2009 to 38% in 2012 and then remained stable through 2018 (37%). In 2019, 36% of children had public coverage.
  • In 2019, Hispanic children were more likely to be uninsured (7%) compared with White, non-Hispanic (4%) and Black, non-Hispanic (3%) children. White, non-Hispanic children were more likely to have private health insurance (69%) compared with Black, non- Hispanic (36%) and Hispanic (36%) children. Black, non-Hispanic (59%) and Hispanic (55%) children were more likely to have public health insurance compared with White, non-Hispanic children (23%).

table icon HC1 HTML Table

41 Sommers, B. D., Gunja, M. Z., Finegold, K., & Musco, T. (2015). Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. JAMA, 314(4), 366–374.

42 Committee on Practice and Ambulatory Medicine, Bright Futures Periodicity Schedule Workgroup. (2021). 2021 recommendations for preventive pediatric health care. Pediatrics, 147(3), Article e2020049776. https://pediatrics.aappublications.org/content/pediatrics/147/3/e2020049776.full.pdf

43 Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq.

44 Title XXI of the Social Security Act, 42 U.S.C. 1397aa–1397mm.

45 Larson, K., Cull, W. L., Racine, A. D., & Olson, L. M. (2016). Trends in access to health care services for US children: 2000–2014. Pediatrics, 138(6), Article e20162176. https://pediatrics.aappublications.org/content/pediatrics/138/6/ e20162176.full.pdf