The amount and type of health
insurance coverage of children and parents/guardians in
Iowa
was evaluated in this study.
Children’s health insurance
coverage
Three percent of children in
Iowa
were uninsured at
the time of the interview. This was half of the rate of uninsured children
found in 2000 (6%). The percentage of children without insurance varied by
income however: only 1% of children in higher income families (i.e., >200%
FPL) were without health insurance. Among children with insurance, about 4% had
been uninsured at some point in the previous 12 months, and lower income
children were most likely to have been without coverage (10%). Seventy percent
of these children were without health insurance for less than 6 months.
Seventy-two percent of children were covered by employer-based insurance,
however, the type of coverage varied significantly by income. About 30% of
lower income children (<133% FPL) had employer-based insurance, while 64% of
moderate income children (134-200% FPL) and 88% of higher income children
(>200% FPL) had such insurance. Public insurance program participation had
the reverse trend (65% of lower income, 27% of moderate income and 5% of higher
income children). The perceived adequacy of insurance coverage also varied by
income: parents of lower income children were most likely to rate their child’s
insurance as excellent (40% vs. 33% for higher income children). Lower income
children, however, were most likely to have had a ‘big’ or ‘moderate’ problem
paying for uncovered services.
Almost all respondents (97%)
indicated that they believed that it was very important for children to have
health insurance, with no difference by age or income status of the child.
Improved insurance coverage did not eliminate parent’s concerns about health
care costs. The parents of one-third of children reported that they worried
either: ‘a great deal’ (8%), ‘somewhat’ (14%) or ‘a little’ (13%), about their
ability to pay for their children’s health care in the previous 12 months.
Higher income parents were significantly less likely to have these concerns.
Questions were asked about the two
public insurance program options for children: Medicaid and hawk-i (
Iowa
’s State
Child Health Insurance Program). Ninety-four percent of all respondents had
heard of the Medicaid program, and one in five children (20%) in
Iowa
not currently
enrolled in Medicaid had been in the program at some point in their lives. This
was highest for lower income children (59%), however, almost one in 8 of the
higher income children had been in the program at some point in their lives
(12%). Almost one-third (29%) of uninsured children had applied for the Medicaid program
since the last time the child had health insurance coverage, but three-quarters
of these children were not eligible because their household income was too
high. For about half of the uninsured children whose families did not apply to
Medicaid, the reason they did not apply was because they thought they would
have incomes too high to qualify. Regarding the hawk-i program, about
three-quarters of respondents were aware of the program, and 6% of children not
currently in the program had been enrolled in hawk-i at some point in
their lives. A slightly higher proportion of uninsured children had applied for hawk-i than Medicaid since the last time the child had health insurance (32%).
Iowa
’s 3% uninsured rate compares favorably
to the national rate of 9% of children without health insurance in 2005.[7]
Iowa
’s
decline from 2000 to 2005 also parallels a national decline in the rate of
uninsured children from the mid 1990s to 2005. The national rate for uninsured
children (non-Hispanic white children) declined from 12.6 percent to 7.9
percent from 1996-2005.[8] Much of this decline is attributed to the start of the State Children’s Health
Insurance Program (SCHIP) in 1997 and the concurrent expansion of eligibility
of Medicaid for children.
Iowa
has seen a similar increase in the number of children enrolled in the Medicaid
and hawk-i programs. From this study, the proportion of children with public insurance has
increased from 11% in 2000 to 20% in 2005 as the number of uninsured children
declined in the state.
Adult’s health insurance coverage
Eleven percent of
Iowa
’s children had parents who were
uninsured at the time of the survey. This was the same percentage of uninsured
parents as in 2000. Figure 6 shows the change in uninsured children compared to
the change for their parents in 2000 and 2005. Eighty-three percent of the
children’s parents had the same insurance plan as their child, down from 88% in
2000. Having the same insurance was most common for higher income children
(88%) and least common for lower income children (70%). Over half of these
adults had employer-based insurance (56% through their employer, 15% through someone
else’s employer), 12% had individually purchased policies, and the rest had
either Medicare or Medicaid (12%) or some other source (4%). This varied by
income: parents of lower income children were more likely to have public
insurance through Medicaid.
In 2005, there were about 5% more
adults who self-purchased their health insurance than in 2000, and
correspondingly about 3% fewer with employer-sponsored insurance. As in 2000,
adults had mixed perceptions about how well their health insurance coverage met
their needs. Just over one-quarter (27%) of children had parents who rated
their coverage as ‘excellent,’ about one-third (35%) rated it as ‘very good,’
one-quarter (24%) as ‘good,’ 10% as ‘fair’ and 3% as ‘poor.’ Parents of higher
income children were most likely to rate their own insurance as ‘excellent’
(30%). Adults considered health insurance to be slightly less important for
themselves than for their children: parents of 89% of children indicated that
it was ‘very important’ for them to
have health insurance (97% for children). Parents of lower income children were
least likely to rate having insurance as ‘very important’ for themselves (79%).
Figure 6. Health insurance
status of children and their parents,
2000 and 2005.\
