title: Changes in health insurance for US children and their parents: comparing 2003 to 2008.
abstract: OBJECTIVE
  Recent policy changes have affected access to health insurance for families in the United States. Private health insurance premiums have increased, and state Medicaid programs have cut back coverage for adults. Concurrently, the Children's Health Insurance Program has made public insurance available to more children. We aimed to better understand how child and parent health insurance coverage patterns may have changed as a result of these policies.
  
  
  METHODS
  We analyzed data from the nationally representative Medical Expenditure Panel Survey, comparing cohorts from 2003 and 2008. We assessed cross-sectional and full-year coverage patterns for child/parent pairs, stratified by income. We conducted chi-square tests to assess significant differences in coverage over time.
  
  
  RESULTS
  Middle-income child/parent pairs had the most significant changes in their coverage patterns. For example, those with full-year health insurance coverage significantly decreased from 85.4% in 2003 to 80.6% in 2008. There was also an increase in uninsured middle-income child/parent pairs for the full year (5.6% in 2003 to 8.3% in 2008) and an increase in pairs who had a gap in coverage (9.7% in 2003 to 13.0% in 2008).
  
  
  CONCLUSIONS
  The percentage of middle-income child/parent pairs who were lacking insurance, for part or all of the year, has risen, suggesting that these families may be caught between affording private coverage and being eligible for public coverage. Unless private coverage becomes more affordable, insurance instability among middle-income families may persist despite the passage of the Patient Protection and Affordable Care Act.
authors: Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA. angierh@ohsu.edu
authors: Heather
authors: H
authors: Angier
authors: Jennifer E
authors: JE
authors: DeVoe
authors: Carrie
authors: C
authors: Tillotson
authors: Lorraine
authors: L
authors: Wallace
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D008137:Longitudinal Studies; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D057566:Self Report; D014481:United States