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America's Children: Key National Indicators of Well-Being, 2019

Health Insurance Coverage

Health insurance is a major determinant of access to healthcare.43 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.44 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 1997.45, 46 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.47, 48

Indicator HC1: Percentage of children ages 0–17 by health insurance coverage status at the time of interview, 1993–2017
Indicator HC1: Percentage of children ages 0–17 by health insurance coverage status at the time of interview, 1993–2017

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), state-sponsored or other government-sponsored health plan, or a military plan. A child was also 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.

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 14% in 1993 to 5% in 2017.
  • The percentage of children with private coverage increased from 66% in 1993 to a high of 69% in 1999, had a long downward trend through 2012, and stabilized in the 53%–55% range through 2017.
  • Public coverage of children had a long upward trend from 1999 to 2012, and then stabilized in the 37%–39% range through 2017.
  • In 2017, the type of health insurance that children had varied by the age of the child. Adolescents were more likely to have private coverage and less likely to have public coverage compared with younger children. Those in the youngest age group, up to age 5, were less likely to be uninsured, and more likely to have public coverage than adolescents ages 12–17.
  • In 2017, Hispanic children were more likely to be uninsured (8%) compared with White, non-Hispanic and Black, non-Hispanic (4% for both) children. White, non-Hispanic children were more likely to have private coverage (69%) compared with Black, non-Hispanic (36%) and Hispanic (34%) children. Black, non-Hispanic (56%) and Hispanic (55%) children were more likely to have public coverage compared with White, non-Hispanic (24%) children.

table icon HC1 HTML Table

43 Kaiser Commission on Medicaid and the Uninsured. (2012). The uninsured and the difference health insurance makes. Menlo Park, CA: Kaiser Family Foundation.

44 American Academy of Pediatrics. (2015). 2016 recommendations for preventive pediatric healthcare. Pediatrics, 137(1), 25–27.

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

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

47 Howell, E., & Kenney, G. M. (2012). The impact of the Medicaid/CHIP expansions on children: A synthesis of the evidence. Medical Care Research and Review, 69(4), 376–392.

48 Selden, T. M., & Hudson, J. L. (2006). Access to care and utilization among children: Estimating the effects of public and private coverage. Medical Care, 44(5), I19–I26.