Health Insurance Coverage of Children, 2010

Congressional research reportFeb 9, 2012

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R42343

CRS Report for Congress

Prepared for Members and Committees of Congress

Health Insurance Coverage of Children, 2010

Summary

In 2010, 90% of children had health insurance coverage in the United States, and 10% of children

were uninsured. Among children with coverage, private health insurance, including employersponsored insurance and nongroup insurance, was the predominant source of coverage, followed

by public coverage, including Medicaid and other means-tested public programs (e.g., the State

Children’s Health Insurance Program—CHIP), as well as Medicare and military health care.

These estimates, and the estimates detailed in this report, are from the U.S. Census Bureau’s

Annual Social and Economic Supplement to the Current Population Survey (CPS, commonly

known as the March Supplement). The CPS is representative of the civilian, noninstitutionalized

population of the United States. National-level estimates in this report are created using the most

recent CPS data, representing data from 2010, as well as historical data from previous years.

State-level estimates are created using a three-year average of CPS data (representing data from

2008 to 2010), which provide reliable state estimates.

The national-level estimates provide only a limited understanding of the health insurance

coverage of children under age 19. To better understand this population, the report provides an

analysis of the variation in coverage by selected demographic and family characteristics,

including age, race, ethnicity, citizenship status, poverty status, and family composition. For

example, in 2010, non-citizen children, Hispanic children, and children not living with at least

one parent/guardian were more likely to be uninsured compared with other children.

Another important factor affecting uninsurance rates among children is the variation across states.

During the 2008-2010 period, the percentage of uninsured children ranged from a high of 17.3%

in Texas to a low of 3.2% in Massachusetts. Not only does coverage vary by states, but the source

of insurance coverage also varies by states. The percentage of children covered by private health

insurance ranged from 80.1% in New Hampshire to 46.9% in Mississippi, and the percentage of

children covered by public coverage ranged from 50.6% in the District of Columbia to 18.3% in

Utah.

Finally, examining changes in coverage and source of coverage over time provides additional

insight into insurance and sources of coverage for children. Between 2000 and 2010, the

uninsured rate among children decreased by about 1 percentage point, while the percentage of

children with private insurance decreased by more than 11 percentage points and the percentage

with public coverage increased by 13.5 percentage points.

As Congress focuses on allocating limited resources to programs such as Medicaid and CHIP, a

deeper understanding of the characteristics of uninsured children may prove useful to inform this

discussion.

Congressional Research Service

Health Insurance Coverage of Children, 2010

Contents

Introduction...................................................................................................................................... 1

Description of the Data.................................................................................................................... 2

Health Insurance Status by Selected Demographic Characteristics................................................. 2

Age ............................................................................................................................................ 3

Race and Ethnicity..................................................................................................................... 3

Citizenship Status ...................................................................................................................... 3

Health Insurance Status by Selected Family Characteristics ........................................................... 5

Poverty Status............................................................................................................................ 5

Family Status ............................................................................................................................. 5

State Estimates of Health Insurance Coverage ................................................................................ 6

Characteristics of Uninsured Children........................................................................................... 10

Trends in Health Insurance Coverage of Children......................................................................... 13

Figures

Figure 1. Percentage of Uninsured Children Under Age 19, by State, 2008-2010 Average ............ 8

Figure 2. Characteristics of Uninsured Children and of All Children Under Age 19, 2010 .......... 12

Figure 3. Health Insurance Status of Children Under Age 19, 2000-2010 .................................... 13

Tables

Table 1. Health Insurance Coverage of Children Under Age 19 in 2010, by Selected

Demographic Characteristics........................................................................................................ 4

Table 2. Health Insurance Coverage of Children Under Age 19 in 2010, by Selected

Family Characteristics .................................................................................................................. 6

Table 3. Health Insurance Coverage Estimates for Children Under Age 19, by State,

2008-2010 Average....................................................................................................................... 9

Contacts

Author Contact Information........................................................................................................... 14

Congressional Research Service

Health Insurance Coverage of Children, 2010

Introduction

Over the years, research has consistently shown that children with health insurance coverage have

better access to health care services and a regular health care provider, which in turn results in

better health outcomes.1 According to the Annual Social and Economic Supplement to the Current

Population Survey (CPS, often called the March Supplement), in 2010, 90.0% of children had

health insurance and 10.0% were uninsured. Similarly, in 2009, 10.2% of children were

uninsured.2

While overall 10.0% of children are uninsured, the uninsured rate among children varies in

different segments of the population. For example, older children are more likely to be uninsured

compared with younger children, and Hispanic children have twice the uninsured rate compared

with non-Hispanic children.3 State factors, such as eligibility levels for public programs (e.g.,

Medicaid) and a state’s health insurance market, also affect the health insurance status of

children. The CPS data show that the uninsured rate among children across the states ranges from

17.3% in Texas to 3.2% in Massachusetts.

Children who have health insurance have either private insurance, public coverage, or both.

Private insurance includes employer-sponsored insurance and nongroup insurance (insurance

purchased in the individual market); public coverage includes Medicaid, the State Children’s

Health Insurance Program (CHIP), and any other means-tested public programs, as well as

Medicare and military health care (e.g., TRICARE and Veterans Administration [VA] Health

Care).4 Children may have more than one source of coverage, and those coverage types could be

different. For example, a child could have employer-sponsored insurance, a type of private

insurance, and Medicaid, a type of public coverage. In 2010, 59.9% of children had private

insurance and 37.2% had public coverage.

Sources of health insurance coverage vary according to a child’s demographic and family

characteristics. For example, in 2010, children living in families with incomes below 100% of the

federal poverty level (FPL) were more likely to have public coverage and less likely to have

private insurance compared with children living in families with higher incomes.

See, for example, Kaiser Commission on Medicaid and the Uninsured, “The Uninsured and the Difference Health

Insurance Makes,” October 2011, http://www.kff.org/uninsured/upload/1420-13.pdf; Jennifer DeVoe, A. Graham, and

L. Krois, et al., “Mind the Gap” in Children’s Health Insurance Coverage: Does the Length of a Child’s Coverage Gap

Matter?,” Ambulatory Pediatrics, vol. 8, no. 2 (2008); G.D. Stevens, M. Seid, and N. Halfon, “Enrolling Vulnerable,

Uninsured but Eligible Children in Public Health Insurance: Association with Health Status and Primary Care Access,”

Pediatrics, vol. 117, no. 4 (2006).

CRS analysis of data from the 2010 Annual Social and Economic Supplement to the CPS.

In this report, comparisons across various characteristics of children (e.g., older children are more likely to be insured

compared with younger children) are comparisons of percentages, not numbers. Comparisons of percentages, or rates,

are useful for comparing across groups that do not share a denominator. However, percentages do not provide

information about the underlying size of the population, which is why population totals are included in the tables of this

report.

For information about these programs, see CRS Report RL32237, Health Insurance: A Primer, by (name redac

ted); CRS Report RL33202,

Medicaid: A Primer, by (name redacted); CRS Report R40444,

State Children’s

Health Insurance Program (CHIP): A Brief Overview, by (name redacted) and (name redacted); CRS Report

R40425, Medicare Primer, coordinated by (name redacted); and CRS Report RL33537, Military Medical Care:

Questions and Answers, by (name redacted).

Congressional Research Service

Health Insurance Coverage of Children, 2010

This report presents estimates of health insurance coverage of children under age 19 in the United

States.5 Table 1 and Table 2 show children’s health insurance coverage by selected demographic

and family characteristics at the national level. Table 3 shows state-level estimates of private

insurance, public coverage, and the uninsured rate, and Figure 1 is a map showing uninsured

rates across states. Figure 2 examines the population of uninsured children at the national level.

Figure 3 examines national trends in children’s health insurance status from 2000 to 2010.

Description of the Data

The estimates in this report are based on data from the Annual Social and Economic Supplement

to the Current Population Survey (CPS).6 The CPS is a monthly survey conducted by the U.S.

Census Bureau and is representative of the civilian, noninstitutionalized population of the United

States. The CPS is used primarily to collect employment data, but it also collects information on

health insurance status, income, and poverty. Approximately 100,000 addresses constitute the

sample households to be interviewed. The CPS sample is designed to represent the nation, states,

and other specified geographies (e.g., regions).7

All estimates in this report at the national level are created using the most recent annual CPS data

(representing data from 2010), as well as historical annual data from previous years. All estimates

in this report at the state level are created using three-year averages of the three most recent years

of CPS data (representing data from 2010, 2009, and 2008). The U.S. Census Bureau

recommends using three-year averages of CPS data to examine state-level estimates because of

the survey’s small sample sizes in many states.8

Health Insurance Status by Selected Demographic

Characteristics

Insurance status differs according to children’s demographic characteristics (age, race, ethnicity,

and citizenship status). A child’s likelihood of being uninsured varies by these demographic

characteristics. For example, older children are more likely to be uninsured compared with

younger children. As shown in Table 1, while 11.8% of children aged 13 to 18 years were without

insurance, 9.1% of children under six years old lacked any source of health insurance. Further,

insurance status varies among children of different races, with children who report their race as

only black being the most likely to be uninsured, and children who report two or more races the

In this report the word “children” will be used to refer to individuals under age 19.

The traditional name of the survey is the March Supplement, but because the supplement has been fielded from

February through April for several years, it has been officially renamed the Annual Social and Economic supplement

(ASEC) to the CPS. Many analysts continue to refer to it as the March supplement.

Several other surveys also produce health insurance estimates, including the American Community Survey (ACS) and

the National Health Institute Survey (NHIS). These surveys, as well as the CPS, have strengths and weaknesses. The

CPS is used in this report for two reasons: 1) the CPS has been and continues to be a data source for the State

Children’s Health Insurance Program (CHIP); 2) the CPS provides a consistent historical time series for health

insurance data.

U.S. Census Bureau, Current Population Survey, 2011 Annual Social and Economic (ASEC) Supplement, September

20, 2011, http://www.census.gov/apsd/techdoc/cps/cpsmar11.pdf.

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Health Insurance Coverage of Children, 2010

least likely to be uninsured. Hispanics are twice as likely to be uninsured compared with nonHispanic children, and non-citizen children are almost four times more likely to be uninsured

compared with citizen children. For those children who have insurance, the source of coverage

also varies by demographic characteristics, as discussed below.

Age

As age increases, children are more likely to have private insurance and less likely to have public

coverage. Slightly over half (54.3%) of children under age six had private insurance, and 43.8%

had public coverage. In comparison, nearly two-thirds of children aged 13 to 18 had private

insurance and under one-third (30.2%) had public coverage. The higher rate of private coverage

among older children does not off-set the lower rate of public coverage; children aged 13 to 18

are more likely to be uninsured compared with children under age six and children aged 6 to 12.

Race and Ethnicity

Examining differences in race show that children who report their race as black alone are less

likely to have private insurance, and more likely to have public coverage. Children who report

their race as white alone or “other alone” (Asian alone, Native American alone, Native

Hawaiian/Other Pacific Islander alone, or some other race alone) have similar rates of coverage.

In both categories, nearly two-thirds of children have private insurance, and about one-third have

public coverage. Among children who report two or more races, over half (55.7%) have private

insurance and 46.3% have public coverage.

The only available ethnicity breakdown in the CPS is Hispanic, non-Hispanic, and the question is

asked independently of race (i.e., a child who is Hispanic could report any race).9 Looking at

ethnicity, two-thirds of non-Hispanic children have private insurance compared with 37.9% of

Hispanic children; however, only one-third of non-Hispanic children have public coverage,

whereas 50.9% of Hispanic children have public coverage.

Citizenship Status

Similar percentages of non-citizen children have private insurance (35.5%), public coverage

(33.4%), and are uninsured (34.9%). In contrast, 60.6% of citizen children have private insurance,

and 37.3% have public coverage.10 Compared with citizen children, non-citizen children are

almost four times more likely to be uninsured.

For more information, see CRS Report RL32701, The Changing Demographic Profile of the United States, by (name

redacted) and (name redacted).

In this report, “citizen” children include both children born in the United States and foreign-born children who are

naturalized citizens of the United States. Because the CPS does not ask about citizenship status (i.e., whether the

individual is legally present in the United States), CRS cannot use the CPS to examine the characteristics of children

who lack legal authorization to be present in the United States.

Congressional Research Service

Health Insurance Coverage of Children, 2010

Table 1. Health Insurance Coverage of Children Under Age 19 in 2010,

by Selected Demographic Characteristics

(Numbers in Thousands)

Private Health Insurance

Public Coverage

Uninsured

Total

Population

Any

Privatea

Employersponsored

Nongroup

Any

Publicb

Medicaid

Other

Publicc

Number

Percent

79,288

59.9%

56.2%

5.8%

37.2%

34.1%

4.1%

7,952

10.0%

Under 6

25,555

54.3%

50.8%

4.9%

43.8%

40.2%

4.6%

2,314

9.1%

6 to 12

28,659

60.4%

56.8%

5.6%

37.5%

34.9%

3.6%

2,675

9.3%

13 to 18

25,074

65.2%

60.8%

6.9%

30.2%

27.1%

4.1%

2,963

11.8%

White alone

59,831

63.5%

59.6%

6.0%

33.4%

30.4%

3.9%

5,938

9.9%

Black alone

11,936

42.0%

39.7%

4.2%

55.4%

52.4%

4.6%

1,335

11.2%

Other alone

4,530

62.5%

57.1%

7.8%

33.4%

30.9%

3.0%

454

10.0%

Two or more

races

2,990

55.7%

52.0%

4.6%

46.3%

41.6%

6.3%

225

7.5%

Hispanic

18,328

37.9%

36.0%

2.9%

50.9%

48.7%

3.3%

3,090

16.9%

Non-Hispanic

60,960

66.5%

62.2%

6.7%

33.1%

29.8%

4.3%

4,862

8.0%

Citizene

77,077

60.6%

56.9%

5.8%

37.3%

34.2%

4.2%

7,179

9.3%

Non-Citizen

2,211

35.5%

31.9%

4.5%

33.4%

32.6%

1.2%

773

34.9%

All Children

Under Age 19

Age

Race

Ethnicityd

Citizenship Status

Source: CRS analysis of data from the 2011 Annual Social and Economic Supplement to the CPS (representing

data from 2010).

Notes: Individuals may report more than one source of coverage, and individuals may report both private and

public coverage; percentages may therefore total to more than 100. Numbers may not add to the total due to

rounding.

Any private insurance includes employer-sponsored insurance and nongroup insurance.

Any public coverage includes Medicaid and other means-tested public programs (e.g., the State Children’s

Health Insurance Program [CHIP]), as well as Medicare and military health care (e.g., TRICARE).

Other public coverage includes Medicare and military health care (e.g., TRICARE).

The only available ethnicity breakdown in the CPS is Hispanic, non-Hispanic, and the question is asked

independently of race.

Includes both children born in the United States and foreign-born children who are naturalized citizens.

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Health Insurance Coverage of Children, 2010

Health Insurance Status by Selected Family

Characteristics

Whether or not children have insurance is also affected by family characteristics. Table 2 shows

health insurance coverage of children by family characteristics at the national level in 2010.

Generally, as family income increases, the percentage of uninsured children decreases—the

uninsured rate for children in families with income below 100% FPL is over four times the rate

for children in families with income equal to or greater than 400% FPL.11 Looking at family

composition, children who live in families with two parents have the lowest uninsured rate

(8.1%), followed by children who live with a single mother (10.9%) and children who live with a

single father (16.0%). A quarter of children who do not live with a parent are uninsured.

Family characteristics can also affect the source of coverage among children with health

insurance, as discussed below. For example, whether a child qualifies for a program such as

Medicaid is in part dependent on family income.12

Poverty Status

As family income increases, the rate of private insurance increases, the rate of public coverage

decreases, and the uninsured rate decreases. For example, 16.3% of children in families with

income below 100% FPL had private insurance, compared with 92.1% of children in families

with income equal to or greater than 400% FPL. The rates of public coverage ranged from 72.7%

among children in families with income below 100% FPL to 10.4% among children in families

with income equal to or greater than 400% FPL.

Family Status

Among children who live with two parents, 71.1% have private insurance, compared with 47.1%

of those who live with a single father and 38.4% of those who live with a single mother. A smaller

percentage of children who live with two parents have public coverage compared with children

who live either with a single father or a single mother. Overall, children who live with at least one

parent are more likely to have private insurance and less likely to have public coverage compared

with children who are not living with a parent.

In the CPS, poverty levels are created using a “poverty index” that provides a range of income cutoffs adjusted by

various factors, including family size. As follows, a family’s income is not the only factor that affects a child’s poverty

status; however, a family’s income is one important determinant of a child’s poverty status. For more information about

how poverty is measured in the United States, see CRS Report R41187, Poverty Measurement in the United States:

History, Current Practice, and Proposed Changes, by (name redacted).

For more information on children’s eligibility for Medicaid, see CRS Report RL33202, Medicaid: A Primer, by

(name redacted).

Congressional Research Service

Health Insurance Coverage of Children, 2010

Table 2. Health Insurance Coverage of Children Under Age 19 in 2010, by Selected

Family Characteristics

(Numbers in Thousands)

Private Health Insurance

Total

Population

Public Coverage

Uninsured

Any

Privatea

Employersponsored

Nongroup

Any

Publicb

Medicaid

Other

Publicc

Number

Percent

All Children

Under Age 19

79,288

59.9%

56.2%

5.8%

37.2%

34.1%

4.1%

7,952

10.0%

Poverty

Statusd

78,866

60.1%

56.3%

5.8%

37.1%

34.0%

4.1%

7,882

10.0%

<100% FPL

17,249

16.3%

14.2%

2.5%

72.7%

70.7%

3.6%

2,774

16.1%

100-199% FPL

16,840

42.0%

38.7%

4.7%

52.5%

49.7%

4.3%

2,452

14.6%

200-299% FPL

13,506

70.0%

65.6%

6.9%

28.7%

25.0%

4.5%

1,362

10.1%

300-399% FPL

9,736

84.3%

80.4%

6.8%

17.7%

13.7%

4.5%

529

5.4%

≥ 400% FPL

21,536

92.1%

87.2%

8.1%

10.4%

7.0%

3.9%

765

3.6%

Child Living

with Parent

75,876

61.3%

57.5%

5.9%

36.5%

33.4%

4.1%

7,084

9.3%

Living with

Two Parents

51,894

71.1%

66.7%

6.9%

28.0%

24.2%

4.6%

4,217

8.1%

Living with

Single Father

4,805

47.1%

43.9%

4.3%

42.7%

40.5%

4.1%

771

16.0%

Living with

Single Mother

19,177

38.4%

36.2%

3.5%

58.1%

56.5%

2.7%

2,097

10.9%

3,412

28.8%

26.0%

3.4%

52.3%

50.4%

3.7%

867

25.4%

Child Not

Living with

Parent

Source: CRS analysis of data from the 2011 Annual Social and Economic Supplement to the CPS (representing

data from 2010).

Notes: Individuals may report more than one source of coverage, and individuals may report both private and

public coverage; percentages may therefore total to more than 100. Numbers may not add to total due to

rounding.

Any private insurance includes employer-sponsored insurance and nongroup insurance.

Any public coverage includes Medicaid and other means-tested public programs (e.g., CHIP), as well as

Medicare and military health care (e.g., TRICARE).

Other public coverage includes Medicare and military health care (e.g., TRICARE).

Population estimates for poverty status are less than total population estimates because the estimates for

poverty status exclude individuals under age 15 who are not related by birth, marriage, or adoption to the

reference person within the individual’s household. For example, foster children under age 15 are included

in the total population estimate, but they are not included in the poverty estimates.

State Estimates of Health Insurance Coverage

Nationwide, health insurance coverage of children is related to children’s demographic

characteristics and family characteristics. Regional and state variation in coverage of children is

likely also affected by these characteristics. Geographic variation may be also affected by a state’s

Congressional Research Service

Health Insurance Coverage of Children, 2010

health insurance market and by state policies, such as eligibility criteria for a state’s Medicaid

program or its CHIP.

Figure 1 shows a map of the uninsured by state, and Table 3 show state-level estimates of health

insurance coverage of children.13 The estimates presented are an average of three years of CPS

data, representing data collected in 2008-2010. The U.S. Census Bureau recommends using a

three-year average when using the CPS to compare coverage across states because of the survey’s

small sample size in some states.14

Figure 1 shows how the uninsured rates compare across states. The four states with the highest

uninsured rates, 15.0% or higher, are Texas, Nevada, Florida, and Arizona. The four states with

the lowest uninsured rates, less than 5.0%, are Massachusetts, Hawaii, New Hampshire, and

Vermont. Generally, states with the lowest uninsured rates for children are located in the Midwest

and Northeast; states with the highest uninsured rates are located in the South and West.

For the purposes of this report, discussions of states include the District of Columbia.

U.S. Census Bureau, Current Population Survey, 2011 Annual Social and Economic (ASEC) Supplement, September

20, 2011, http://www.census.gov/apsd/techdoc/cps/cpsmar11.pdf.

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Health Insurance Coverage of Children, 2010

Figure 1. Percentage of Uninsured Children Under Age 19, by State,

2008-2010 Average

Includes Rank of States from Highest Percentage of Uninsured Children (1) to Lowest Percentage of

Uninsured Children (51)

Source: CRS analysis of data from the 2009-2011 Annual Social and Economic Supplement to the CPS

(representing data from 2008 to 2010).

Table 3 provides estimates of private insurance, public coverage, and the uninsured for children,

with percentage rankings by state. The five states with the highest percentage of children covered

by private insurance were New Hampshire (80.1%), Utah (76.8%), Connecticut (74.8%), North

Dakota (74.3%), and Wisconsin (74.0%). The five states with the highest percentage of children

covered by public coverage were the District of Columbia (50.6%), Mississippi (47.7%),

Arkansas (47.4%), New Mexico (44.8%), and Vermont (43.9%).

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Health Insurance Coverage of Children, 2010

Table 3. Health Insurance Coverage Estimates for Children Under Age 19, by State,

2008-2010 Average

(Numbers in Thousands)

Private Health Insurancea

Public Coverageb

Percent

Uninsured

Percent

Total

Population

Number

Value

Rank

Number

Value

Rank

Number

Value

Rank

79,096

48,596

61.4%

27,979

35.4%

7,933

10.0%

Alabama

1,195

718

60.1%

477

39.9%

7.2%

Alaska

196

115

58.5%

41.2%

12.7%

Arizona

1,841

980

53.2%

697

37.8%

277

15.0%

Arkansas

748

378

50.6%

355

47.4%

9.7%

California

10,012

5,635

56.3%

3,865

38.6%

1,095

10.9%

Colorado

1,305

892

68.4%

360

27.6%

128

9.8%

Connecticut

862

645

74.8%

213

24.7%

6.2%

Delaware

223

150

67.4%

31.3%

8.1%

District of

Columbia

117

50.0%

50.6%

6.5%

Florida

4,243

2,417

57.0%

1,420

33.5%

699

16.5%

Georgia

2,724

1,601

58.8%

1,005

36.9%

305

11.2%

Hawaii

311

207

66.5%

136

43.6%

3.5%

Idaho

443

295

66.6%

138

31.2%

9.6%

Illinois

3,352

2,090

62.4%

1,206

36.0%

261

7.8%

Indiana

1,729

1,102

63.7%

638

36.9%

120

7.0%

Iowa

762

550

72.2%

234

30.7%

6.4%

Kansas

751

487

64.9%

252

33.6%

8.8%

Kentucky

1,070

630

58.8%

428

39.9%

8.7%

Louisiana

1,214

665

54.7%

511

42.0%

115

9.4%

Maine

287

184

64.1%

117

40.6%

5.0%

Maryland

1,417

1,018

71.9%

384

27.1%

104

7.3%

Massachusetts

1,553

1,144

73.7%

452

29.1%

3.2%

Michigan

2,512

1,732

68.9%

833

33.2%

131

5.2%

Minnesota

1,311

964

73.6%

355

27.1%

5.9%

Mississippi

825

387

46.9%

393

47.7%

106

12.8%

Missouri

1,510

1,024

67.8%

480

31.8%

127

8.4%

Montana

229

141

61.6%

34.8%

10.4%

Nebraska

479

330

68.9%

146

30.4%

8.6%

Nevada

710

460

64.7%

171

24.1%

117

16.5%

New Hampshire

305

244

80.1%

20.9%

4.4%

State

United Statesc

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Health Insurance Coverage of Children, 2010

Private Health Insurancea

Public Coverageb

Percent

Uninsured

Percent

Total

Population

Number

Value

Rank

Number

Value

Rank

Number

Value

Rank

New Jersey

2,181

1,557

71.4%

533

24.4%

210

9.6%

New Mexico

545

258

47.3%

244

44.8%

14.9%

New York

4,702

2,857

60.8%

1,821

38.7%

356

7.6%

North Carolina

2,446

1,376

56.3%

984

40.2%

258

10.6%

North Dakota

155

115

74.3%

25.2%

8.0%

2,874

1,926

67.0%

909

31.6%

222

7.7%

Oklahoma

977

555

56.8%

424

43.5%

106

10.9%

Oregon

913

590

64.6%

282

30.9%

103

11.3%

Pennsylvania

2,951

2,011

68.1%

913

30.9%

220

7.5%

Rhode Island

246

160

65.2%

35.9%

6.8%

South Carolina

1,148

693

60.4%

371

32.4%

152

13.3%

South Dakota

211

142

67.2%

34.0%

8.7%

Tennessee

1,563

904

57.9%

670

42.9%

124

7.9%

Texas

7,288

3,598

49.4%

2,845

39.0%

1,261

17.3%

Utah

915

703

76.8%

167

18.3%

10.8%

Vermont

132

64.0%

43.9%

4.7%

Virginia

1,994

1,414

70.9%

586

29.4%

154

7.7%

Washington

1,678

1,031

61.4%

708

42.2%

101

6.0%

West Virginia

416

257

61.9%

182

43.6%

5.0%

Wisconsin

1,386

1,026

74.0%

419

30.2%

5.0%

Wyoming

141

67.5%

32.2%

9.5%

State

Ohio

Source: CRS analysis of data from the 2009-2011 Annual Social and Economic Supplement to the CPS

(representing data from 2008 to 2010).

Notes: Individuals may report more than one source of coverage, and individuals may report both private and

public coverage; percentages may therefore total to more than 100. Numbers may not add to total due to

rounding.

Private health insurance coverage includes employer-sponsored insurance and nongroup insurance.

Public coverage includes Medicaid and other means-tested public programs (e.g., the State Children’s Health

Insurance Program), as well as Medicare and military health care (e.g., TRICARE).

The estimates in this table are based on an average of three years of CPS data; the estimates in Table 1 and

Table 2 are based on one year of CPS data.

Characteristics of Uninsured Children

As noted in the preceding discussion, health insurance coverage of children is likely influenced

by children’s demographic and family characteristics as well as state-specific factors (e.g.,

Congressional Research Service

Health Insurance Coverage of Children, 2010

eligibility criteria for programs such as Medicaid). Figure 2 shows the characteristics of children

who are uninsured and characteristics of all children at the national level in 2010.

Figure 2 illustrates that some characteristics of uninsured children are different from the

characteristics of the total population of children (“all children”). 15 Compared with all children,

children who lack health insurance are more likely to be Hispanic, non-citizens, live in families

with low income, and not live with a parent. Hispanic children represent 23.1% of all children,

but they represent nearly 40% of uninsured children. Non-citizen children represent 2.7% of all

children, and 9.7% of uninsured children. Children living in families with income below 100%

FPL represent 21.9% of all children, and 35.2% of uninsured children. In contrast, children living

in families with income equal to or greater than 400% FPL represent 27.3% of all children and

9.7% of uninsured children. Children not living with at least one parent represent 4.3% of all

children and 10.9% of uninsured children.16

It should be noted that the 2011 CPS (like previous CPS surveys) asks whether each individual had various types of

health insurance at any point 2010. Those who responded that they did not have any health insurance were considered

uninsured in 2010. This wording implies that the uninsurance variable measures where an individual lacked health

insurance for the entire year; however, researchers have found that the estimates of uninsured in the CPS resemble

uninsured estimates from other surveys’ point-in-time estimates (i.e., estimates from the American Community

Survey). Many researchers have concluded, therefore, that it is reasonable to interpret the CPS uninsurance estimate as

a point-in-time estimate. For more information, see Congressional Budget Office, How Many People Lack Health

Insurance and for How Long? Economic and Budget Issue Brief, Washington, DC, 2003.

The percentages compared in this section and in Figure 2 are based on numbers found in Table 1 and Table 2.

Congressional Research Service

Figure 2. Characteristics of Uninsured Children and of All Children Under Age 19, 2010

Source: CRS analysis of data from the 2011 Annual Social and Economic Supplement to the CPS (representing data from 2010).

1 The only available ethnicity breakdown in the CPS is Hispanic, non-Hispanic, and the question is asked independently of race.

2 Includes both children born in the United States and foreign-born children who are naturalized citizens.

CRS-12

Health Insurance Coverage of Children, 2010

Trends in Health Insurance Coverage of Children

Examining children’s health insurance coverage over time is one way to assess how economic

conditions and program changes (i.e., changes to CHIP eligibility) affect children’s coverage.

Figure 3 shows national-level estimates of children who were uninsured and who had private

insurance and public coverage between 2000 and 2010. The percentage of children who were

uninsured fluctuated slightly during the period, between 2000 and 2010, decreasing 1.1

percentage points, from 11.1% to 10.0%.

The slight fluctuations of the percentage of children who were uninsured were likely affected by

the larger changes in the percentage of children who had private health insurance and those who

had public coverage over the time period. In 2000, 71.2% of children had private health

insurance, but by 2010, the percentage dropped to 59.9%, a nearly 16% decline in private health

insurance coverage for children. Over that same period, the percentage of children with public

coverage increased from 23.7% in 2000 to 37.2% in 2010, a 57% increase in public coverage for

children. Periods of economic recessions, as denoted by the gray bars in Figure 3, may provide

additional insight into changes in children’s health insurance coverage during those periods.

Figure 3. Health Insurance Status of Children Under Age 19, 2000-2010

Source: 2011 March Supplement to the CPS (representing data from 2010).

Notes: Data were downloaded from the State Health Access Data Assistance Center (SHADAC) data center,

available at http://www.shadac.org/datacenter. Data were accessed January 4, 2012.

Congressional Research Service

Health Insurance Coverage of Children, 2010

Individuals may report more than one source of coverage, and individuals may report both private and public

coverage; percentages may therefore total to more than 100.

The gray shaded areas represent period of economic recessions, as officially defined by the National Bureau of

Economic Research (NBER). For more information, see http://www.nber.org/cycles.html.

Author Contact Information

(name redacted)

Analyst in Health Care Financing

[redacted]@crs.loc.gov, 7-....

Congressional Research Service

(name redacted)

Analyst in Health Care Financing

[redacted]@crs.loc.gov, 7-....

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