Survey Results Find High Rate of Inadequate Health Care Coverage Among US Children


There is a great need to protect families and children that are commercially insured following the COVID-19 pandemic.

Insurance gaps have impacted both publicly and commercially insured children, according to research released by Columbia University Mailman School of Public Health. The study analyzed parent or caregiver-reported information regarding health insurance data among children from 0 to 17 years old—detecting inconsistent and inadequate coverage in each insurance type.

Male pediatrician hold stethoscope exam child boy patient- Image credit: Fizkes |

Image credit: Fizkes |

Children were deemed to have inadequate insurance if they failed to meet 3 criteria: if benefits were adequate to meet a child’s needs, if the coverage allowed the child to see needed health care providers, and if there was an absence of reasonable annual out-of-pocket payments for the child’s health care.

In comparison, children deemed to have inconsistent coverage were 3 times higher among children that were publicly insured. However, more children were reported to have inadequate insurance, which impacted 1 in 5 United States children.

“While uninsurance among children has generally been declining in the US, our results highlight the need for a renewed focus on making sure that children’s coverage is affordable for families and provides the benefits that children need” said Jamie Daw, PhD, assistant professor of health policy and management at Columbia Mailman School of Public Health, in a press release.

The data were collected from the 2016-2021 National Survey of Children’s Health. Prior to analyzing the children’s health insurance data, the researchers compared significant changes during the COVID-19 pandemic and how it impacted coverage.

The survey included 203,691 insured children with 34.5% publicly insured and 65.5% commercially insured, according to the study authors.

The results found that children that were publicly insured displayed higher rates of inconsistent coverage, compared to commercially insured children—at 4.2% and 1.4%, respectively. As a result, these children also had lower rates of inadequate coverage, whereas commercially insured children had higher rates.

The study authors noted that insurance gaps were more common among children that were publicly insured, but during the COVID-19 pandemic, insurance gaps decreased for both insurance groups. The researchers noted that this was due to additional subsidies for commercial insurance and the requirements for certain states to keep Medicaid beneficiaries enrolled.

However, the results found that as the pandemic concluded in 2023, children that were publicly insured have lost coverage that was gained during COVID-19.

“Federal COVID-19 relief policies prevented states from dis-enrolling children on Medicaid and instituted enhanced subsidies for private Marketplace coverage. Our study findings suggest these policies made an important difference for families during the pandemic: publicly insured children had fewer coverage gaps and coverage was more affordable for commercially insured children. Policymakers should be actively considering how to maintain and build on these gains," said Daw, in a press release.

The findings highlighted the needs of protecting families and children that are commercially insured that face high out-of-pocket costs and are unable to access an in-network provider to aid the child’s needs.


Millions of kids in U.S. have inadequate health care coverage. EurekAlert!. News release. November 28, 2023. Accessed November 30, 2023.

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