Uninsured Parents Still Feel That Affordable Health Coverage Is Out of Reach

New data from the Urban Institute’s Health Policy Institute’s Health Reform Monitoring Surveys (HRMS) found that the share of US parents with health insurance coverage increased 6.4% and the share of children with health insurance coverage increased 17% from September 2013, just before major coverage provisions of the Affordable Care Act (ACA), to September 2015, after the completion of the second open enrollment period following ACA approval.

Relative to 2013, parents surveyed were also more likely to report having a usual source of healthcare and having had a routine checkup in the past year. The parents reported that they had less trouble finding a doctor in the past year.

The analysis of the new nationally representative data from surveys of approximately 7500 nonelderly adults also showed that parents reported higher satisfaction with their premiums and the protection against high medical bills that their health plans provided, as well as higher satisfaction with several aspects of their children’s plans.

The surveys gathered information on approximately 2400 children. While children were not the primary target of the ACA’s coverage provisions, coverage was expected to increase among children under the ACA because of policies including the expansion of Medicaid to more parents, tax credits for Marketplace coverage, new outreach and enrollment efforts, and the individual mandate. Several federal surveys have found declines in the number of uninsured children since 2013.

Although the parents were less likely to report that they went without care because of affordability reasons, the Urban Institute’s survey data found that many parents remained uninsured in 2015. Nearly two-thirds of uninsured parents (65.2%) cited the costs of insurance or their inability to afford insurance as a reason for not having coverage. The second most frequently cited reason was that parents were in transition between different types of coverage (13.7%), and another 7.1% said they did not know how to find information about the available options. About 13% of uninsured parents reported that they did not want coverage.

Nearly 6 in 10 of the uninsured parents reported that their family often or sometimes ran out of food in the previous 12 months, nearly twice the proportion of insured parents. Some 45% of uninsured parents reported that they often or sometimes were unable to pay the rent, mortgage, or other housing costs. Many of the uninsured parents have family incomes at or below the federal poverty level and live in states that did not expand Medicaid before September 1, 2015; they were likely to be in the “assistance gap” with incomes too high to qualify for Medicaid but not high enough for tax credits to purchase health insurance.

These statistics indicate that many uninsured parents feel that affordable health insurance coverage is beyond their reach and that a large share struggles to meet their families’ basic needs. Survey author Michael Karpman and colleagues conclude that steps to make coverage more affordable, either through expansions of Medicaid in the 20 states that have not yet expanded eligibility or increased financial assistance for Marketplace coverage are likely to be critical to building on the gains in health insurance coverage that parents have experienced since the ACA’s major coverage provisions took effect. Finally, better outreach programs are needed to increase awareness and understanding of the value of insurance and how to obtain it.