Uninsured but eligible children: are their parents insured? Recent findings from Oregon.
BACKGROUND
Despite expansions in public health insurance programs, millions of US children lack coverage. Nearly two-thirds of Oregon's uninsured children seem to be eligible for public insurance.


OBJECTIVE
We sought to identify uninsured but eligible children and to examine how parental coverage affects children's insurance status.


METHODS
We collected primary data from families enrolled in Oregon's food stamp program, which has similar eligibility requirements to public health insurance in Oregon. In this cross-sectional, multivariable analysis, results from 2861 surveys were weighted back to a population of 84,087 with nonresponse adjustment. Key predictor variables were parental insurance status and type of insurance; the outcome variable was children's insurance status.


RESULTS
Nearly 11% of children, presumed eligible for public insurance, were uninsured. Uninsurance among children was associated with being Hispanic, having an employed parent, and higher household earnings (133-185% of the federal poverty level). Children with an uninsured parent were more likely to be uninsured, compared with those who had insured parents (adjusted odds ratio 14.21, 95% confidence interval 9.23-20.34). More surprisingly, there was a higher rate of uninsured children among privately-insured parents, compared with parents covered by public insurance (adjusted odds ratio 4.39, 95% confidence interval 2.00-9.66).


CONCLUSIONS
Low-income Oregon parents at the higher end of the public insurance income threshold and those with private insurance were having the most difficulty keeping their children insured. These findings suggest that when parents succeed in pulling themselves out of poverty and gaining employment with private health insurance coverage, children may be getting left behind.
DeVoe
Jennifer E
JE
Department of Family Medicine, Oregon Health and Science University, Portland, Oregon 97239, USA. devoej@ohsu.edu
Krois
Lisa
L
Edlund
Christine
C
Smith
Jeanene
J
Carlson
Nichole E
NE
D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004608:Eligibility Determination / Q000458:organization & administration; D005190:Family; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D017057:Medically Uninsured; D009922:Oregon; D044469:Racial Groups; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000458:organization & administration*; D014481:United States