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America's Children in Brief: Key National Indicators of Well-Being, 2020

Health Insurance Coverage

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.25 Health insurance is a major determinant of access to health care.26 Children with health insurance are more likely than children without insurance to have a regular and accessible source of health care. The percentage of children who have health insurance is one indication of the extent to which families can obtain preventive care or health care for a sick or injured child.27, 28

Figure 8: Percentage of children ages 0–17 by health insurance coverage status at the time of interview and metropolitan status, 2018
Percentage of children ages 0–17 by health insurance coverage status at the time of interview and metropolitan status, 2018

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. The U.S. Office of Management and Budget classifies counties as within a metropolitan or a micropolitan statistical area. The remaining counties are not classified and are considered rural in this report. Rural counties may include small urban areas, as well as completely rural areas. Nonmetropolitan counties include counties in micropolitan statistical and rural areas.

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

  • In 2018, 55% of children ages 0–17 had private health insurance, 37% had public health insurance, and 5% were uninsured.
  • The percentage of children ages 0–17 who were uninsured was higher for those living in micropolitan counties (8%) compared with those living in metropolitan counties (5%).
  • The percentage of children ages 0–17 with private health insurance was higher for those living in metropolitan counties (56%) compared with those living in micropolitan counties (47%).
  • The percentage of children ages 0–17 with public health insurance was lower for those living in metropolitan counties (36%) compared with those living in micropolitan (43%) and rural counties (45%).

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25 American Academy of Pediatrics. (2015). 2016 recommendations for preventive pediatric healthcare. Pediatrics, 137(1), 25–27. Retrieved from https://pediatrics.aappublications.org/content/pediatrics/137/1/e20153908.full.pdf

26 Kaiser Commission on Medicaid and the Uninsured. (2012). The uninsured and the difference health insurance makes [Fact sheet]. Menlo Park, CA: Kaiser Family Foundation. Retrieved from https://www.kff.org/wp-content/uploads/2013/01/1420-14.pdf

27 Howell, E. M., & 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), 372–396. https://doi.org/10.1177/1077558712437245

28 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), I-19–I-26. https://doi.org/10.1097/01.mlr.0000208137.46917.3b