Library Index :: Childhood and Adulthood in America :: Health and Safety - Life Expectancy, Infant Mortality, Fetal Alcohol Syndrome (fas), Mortality Among Children, Hiv/aids

Health and Safety - Health Insurance

Coverage Levels

According to the U.S. Census Bureau, 11.4% of American children—8.4 million—had no health insurance coverage in 2003. Factors affecting children's access to coverage included their age, race and ethnicity, and family's economic status. Children between the ages of twelve and seventeen were less likely to receive coverage than those under twelve (12.7% versus 10.6%). Poor children were more likely to be uninsured than their wealthier counterparts (19.2% versus 11.4%), and those of Hispanic origin were the least likely racial or ethnic group to receive health insurance coverage, with 21% of them being uninsured. Uninsured rates for other racial and ethnic groups were 7.4% for non-Hispanic white children, 12.4% for Asian-American children, and 14.5% for African-American children (U.S. Bureau of the Census, Income, Poverty, and Health Insurance Coverage in the United States: 2003, 2004). The National Center for Health Statistics estimates that 13.7% of all children were uninsured for at least part of 2003 (Robin A. Cohen and Zakia Coriaty-Nelson, Health Insurance Coverage: Estimates from the National Health Interview Survey, 2003, June 30, 2004, http://www.cdc.gov/nchs/nhis.htm [accessed July 30, 2004]).

TABLE 5.7

Diagnoses of AIDS in children younger than 13, by year of diagnosis and exposure category, 1998–2002
Year of diagnosis Cumulative through 2002
1998 1999 2000 2001 2002
Note: These numbers do not represent actual cases in persons with a diagnosis of AIDS. Rather, these numbers are point estimates of cases diagnosed that have been adjusted for reporting delays and for redistribution of cases in persons initially reported without an identified risk. The estimates have not been adjusted for incomplete reporting.
aIncludes children with a diagnosis of AIDS, from the beginning of the epidemic through 2002.
bIncludes children of unknown or multiple race. Cumulative total includes 17 children of unknown or multiple race. Because column totals were calculated independently of the values for the subpopulations, the values in each column may not sum to the column total.
SOURCE: "Table 4. Estimated Numbers of Diagnoses of AIDS in Children < 13 Years of Age, by Year of Diagnosis and Exposure Category, 1998–2002," in HIV/AIDS Surveillance Report, vol. 14, Centers for Disease Control and Prevention, 2003, http://www.cdc.gov/hiv/stats/hasr1402/table4.htm (accessed September 3, 2004)
Race/ethnicity
White, not Hispanic 33 19 13 16 7 1,606
Black, not Hispanic 156 129 85 70 58 5,476
Hispanic 47 33 18 22 24 2,111
Asian/Pacific Islander 0 1 2 2 1 59
American Indian/Alaska Native 1 0 0 0 0 31
Exposure category
Hemophilia coagulation disorder 0 0 0 0 0 236
Mother with, or at risk for, HIV infection 236 181 115 106 90 8,629
Injection drug use 46 43 20 13 9 3,309
Sex with injection drug user 31 24 15 5 5 1,526
Sex with bisexual male 6 6 2 3 4 202
Sex with person with hemophilia 1 2 0 1 0 35
Sex with HIV-infected transfusion recipient 1 0 0 0 0 26
Sex with HIV-infected person, risk not specified 62 50 36 32 32 1,453
Receipt of blood transfusion, blood components, or tissue 0 1 2 2 3 159
Has HIV infection, risk not specified 89 55 40 50 37 1,920
Receipt of blood transfusion, blood components, or tissue 1 0 1 0 1 390
Other/risk not reported or identified 0 2 2 3 0 45
Totalb 238 183 118 110 92 9,300

In 2002 government programs, such as Medicare, Medicaid, and military insurance, covered 27% of all children. Forty-four percent of African-American children and 40% of Hispanic children had government insurance, compared with only 18% of white, non-Hispanic children.

Child health insurance coverage increased among all age groups, races, and ethnicities from 1998 to 2002 by about 3%. (See Table 5.10.) In a December 31, 2002, press release ("HHS Issues New Report Showing More American Children Received Health Insurance in Early 2002," National Center for Health Statistics), Health and Human Services Secretary Tommy G. Thompson attributed ongoing increases to a push to provide more government coverage, particularly under the State Children's Health Insurance Program (SCHIP). This trend, however, may be leveling off. The National Center for Health Statistics stated that the decrease in uninsured children from 2002 to 2003 was not statistically significant, and the U.S. Census Bureau reported no change in the number of covered children from 2002 to 2003. (See Figure 5.2.)

Medicaid Coverage

In 2002 Medicaid covered 23.9% of children younger than eighteen. (See Figure 5.3.) More than two out of five African-American children (41.2%) and 37.3% of Hispanic children were covered by Medicaid, compared with 15.5% of non-Hispanic white children, and 18.1% of Asian children. In 2000 51% of all those served by Medicaid were children.

To remain in the Medicaid program, families must have their eligibility reassessed at least every six months. If family income or other circumstances change even slightly, the family can lose its eligibility for the Medicaid program, disrupting health care coverage.

The State Children's Health Insurance Program (SCHIP)

From the late 1980s through the mid-1990s, the numbers of uninsured American children rose as coverage rates for employer-sponsored health insurance declined, even though the proportion of children covered by Medic-aid also rose. In 1997, as part of the Balanced Budget Act, Congress created the State Children's Health Insurance Program (SCHIP) to expand health insurance to children whose families earned too much money to be eligible for Medicaid but not enough money to pay for private insurance. SCHIP provides funding to states to insure children, offering three alternatives: states may use SCHIP funds to establish separate coverage programs, expand their Medicaid coverage, or use a combination of both. By September 1999 all fifty states had SCHIP plans in place. By September 4, 2003, the program had been expanded to enroll even more children at higher income levels.

TABLE 5.8

Percentage of children vaccinated for selected diseases, by poverty status, race, and Hispanic origin, 1996–2002
Total Below poverty At or above poverty
Characteristic 1996 1997 1998 1999 2000 2001 2002 1996 1997 1998 1999 2000 2001 2002 1996 1997 1998 1999 2000 2001 2002
— = not available
Note: ( ) is the NIS Web site's footnote.
aThe 4:3:1:3 combined series consists of 4 (or more) doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP), 3 (or more) doses of polio vaccine, 1 (or more) dose of a measles-containing vaccine (MCV), and 3 (or more) doses of Haemophilus influenzae type b (Hib) vaccine.
bThe 4:3:1 combined series consists of 4 (or more) doses of diphtheria and tetanus toxoids and pertussis vaccine (DTP), 3 (or more) doses of polio vaccine, and 1 (or more) dose of a measles containing vaccine (MCV).
c(Four or more doses of any diphtheria and tetanus toxoids and pertussis vaccines including diphtheria and tetanus toxoids, and any acellular pertussis vaccine (DTP/DTaP/DT)) Diphtheria and tetanus toxoids and pertussis vaccine.
d(One or more doses of measles-mumps-rubella vaccine; previous reports of vaccination coverage were for measles-containing vaccine (MCV). Immunization providers respondents were asked about measles-containing vaccine, including MMR (measles mumps rubella) vaccines.
e(Three or more doses of) Haemophilus influenzae type b (Hib) vaccine.
fThe percentage of children 19 to 35 months of age who received 3 (or more) doses of hepatitis B vaccine was low in 1994, because universal infant vaccination with a 3-dose series was not recommended until November 1991.
g(One or more doses of varicella at or after child's first birthday, unadjusted for history of varicella illness). Recommended in July 1996. Administered on or after the first birthday, unadjusted for history of varicella illness (chicken pox).
hPersons of Hispanic origin may be of any race.
SOURCE: "Childhood Immunization: Percentage of Children Ages 19 to 35 Months Vaccinated for Selected Diseases by Poverty Status, Race, and Hispanic Origin, 1996–2002," in America's Children in Brief: KeyNational Indicators of Well-Being, 2004, Federal Interagency Forum on Child and Family Statistics, 2004, http://www.childstats.gov/ac2003/tbl.asp?iid123&id4&indcode HEALTH4 (accessed August 24, 2004)
Total
Combined series (4:3:1:3)a 76 76 79 78 76 77 78 69 71 74 73 71 72 72 80 79 82 81 78 79 79
Combined series (4:3:1)b 78 78 81 80 78 79 79 72 72 76 75 72 73 73 81 80 83 82 79 80 80
DTP (4 doses or more)c 81 82 84 83 82 82 82 74 76 80 79 76 77 75 84 84 86 85 84 84 84
Polio (3 doses or more) 91 91 91 90 90 89 90 88 89 90 87 87 87 88 92 92 92 91 90 90 91
Measles-containing (MCV)d 91 90 92 92 91 91 92 87 86 90 90 89 89 90 92 92 93 92 91 92 92
Hib (3 doses or more)e 91 93 93 94 93 93 93 87 90 91 91 90 90 90 93 94 95 95 95 94 94
Hepatitis B (3 doses or more)f 82 84 87 88 90 89 90 78 81 85 87 87 87 88 83 85 88 89 91 90 90
Varicellag 12 26 43 58 68 76 81 5 17 41 55 64 74 79 15 29 44 58 69 77 81
White, non-Hispanic
Combined series (4:3:1:3)a 79 79 82 81 79 79 80 68 72 77 76 73 71 72 80 80 83 82 80 80 81
Combined series (4:3:1)b 80 80 83 82 80 80 81 70 73 79 77 74 72 73 82 82 84 83 81 81 82
DTP (4 doses or more)c 83 84 87 86 84 84 84 72 76 82 81 78 75 75 85 85 88 86 85 85 86
Polio (3 doses or more) 92 92 92 90 91 90 91 88 90 91 88 88 87 88 93 92 93 91 91 91 92
Measles-containing (MCV)d 91 91 93 92 92 92 93 85 84 90 90 88 87 91 93 93 94 93 92 92 93
Hib (3 doses or more)e 93 94 95 95 95 94 94 87 90 92 93 92 89 88 94 95 96 95 95 95 95
Hepatitis B (3 doses or more)f 82 85 88 89 91 90 91 76 80 87 88 88 86 86 83 85 88 89 92 90 92
Varicellag 15 28 42 56 66 75 79 6 17 38 51 58 67 75 16 29 43 57 68 76 80
Black, non-Hispanic
Combined series (4:3:1:3)a 74 73 73 74 71 71 71 69 71 72 72 69 69 68 79 77 74 77 72 74 72
Combined series (4:3:1)b 77 74 74 75 72 73 72 73 72 74 74 70 71 69 81 78 76 78 73 75 73
DTP (4 doses or more)c 79 77 77 79 76 76 76 74 76 77 78 75 74 74 83 80 79 83 78 78 77
Polio (3 doses or more) 90 89 88 87 87 85 87 87 89 88 86 85 84 87 93 91 87 88 87 86 87
Measles-containing (MCV)d 90 89 89 90 88 89 90 88 87 89 90 88 88 90 91 91 90 91 87 90 90
Hib (3 doses or more)e 89 91 90 92 93 90 92 86 91 90 91 92 87 88 93 94 90 94 93 91 94
Hepatitis B (3 doses or more)f 82 82 84 87 89 85 88 78 82 86 86 89 85 89 85 84 83 90 90 85 88
Varicellag 9 21 42 58 67 75 83 N/A 16 40 57 60 71 80 13 27 44 60 72 77 84
Hispanich
Combined series (4:3:1:3)a 71 73 75 75 73 77 76 68 70 73 73 70 73 75 73 77 79 78 74 79 76
Combined series (4:3:1)b 74 75 77 77 75 79 77 71 71 76 76 73 76 76 75 77 80 80 75 80 77
DTP (4 doses or more)c 77 78 81 80 79 83 79 74 75 79 78 76 79 78 78 81 83 82 80 83 80
Polio (3 doses or more) 89 90 89 89 88 91 90 88 88 90 89 88 90 89 90 90 90 90 87 91 91
Measles-containing (MCV)d 88 88 91 90 90 92 91 87 85 90 90 90 91 91 89 90 92 91 90 93 89
Hib (3 doses or more)e 89 90 92 92 91 93 92 87 89 92 91 88 91 93 90 92 94 95 93 94 92
Hepatitis B (3 doses or more)f 81 81 86 89 88 90 90 80 79 83 87 87 88 89 81 84 88 88 90 91 89
Varicellag 8 22 47 61 70 80 82 6 18 44 59 70 81 82 11 25 49 62 70 82 81

TABLE 5.9

Health care visits to doctor's offices, emergency departments, and home visits over a 12-month period, according to selected characteristics, selected years, 1997–2001
(Data are based on household interviews of a sample of the civilian noninstitutionalized population)
Number of health care visits1
None 1–3 visits 4–9 visits 10 or more visits
Characteristic 1997 1999 2001 1997 1999 2001 1997 1999 2001 1997 1999 2001
Percent distribution
All persons2,3 16.5 17.5 16.5 46.2 45.8 45.8 23.6 23.3 24.4 13.7 13.4 13.3
Age
Under 18 years 11.8 12.4 11.6 54.1 54.4 54.6 25.2 25.0 26.1 8.9 8.2 7.6
Under 6 years 5.0 5.9 5.5 44.9 45.9 45.8 37.0 36.8 37.9 13.0 11.3 10.8
6–17 years 15.3 15.5 14.6 58.7 58.5 58.9 19.3 19.4 20.5 6.8 6.7 6.1
18–44 years 21.7 24.2 23.3 46.7 45.8 46.1 19.0 17.8 18.9 12.6 12.3 11.8
18–24 years 22.0 24.8 25.4 46.8 46.1 44.7 20.0 17.8 19.5 11.2 11.4 10.5
25–44 years 21.6 24.0 22.6 46.7 45.7 46.5 18.7 17.8 18.7 13.0 12.6 12.2
45–64 years 16.9 16.9 15.6 42.9 42.4 42.9 24.7 25.0 25.7 15.5 15.7 15.9
45–54 years 17.9 18.4 17.1 43.9 43.2 44.9 23.4 22.8 23.6 14.8 15.7 14.4
55–64 years 15.3 14.7 13.3 41.3 41.1 39.6 26.7 28.4 28.9 16.7 15.8 18.2
65 years and over 8.9 7.9 7.1 34.7 34.3 32.3 32.5 34.1 35.6 23.8 23.7 25.0
65–74 years 9.8 8.6 8.1 36.9 36.9 35.8 31.6 33.2 33.5 21.6 21.3 22.6
75 years and over 7.7 7.2 5.8 31.8 31.1 28.2 33.8 35.1 38.1 26.6 26.6 27.9
Sex3
Male 21.3 23.1 21.3 47.1 45.5 46.5 20.6 20.6 21.6 11.0 10.8 10.7
Female 11.8 12.0 11.9 45.4 46.1 45.1 26.5 25.9 27.1 16.3 15.9 15.9
Race3,4
White only 16.0 16.9 15.9 46.1 45.7 45.7 23.9 23.8 24.8 14.0 13.6 13.5
Black or African American only 16.8 18.4 16.4 46.1 46.2 46.4 23.2 21.9 24.0 13.9 13.5 13.2
American Indian and Alaska Native only 17.1 20.6 *21.4 38.0 34.3 36.4 24.2 27.8 25.4 20.7 17.2 16.9
Asian only 22.8 23.1 20.8 49.1 47.3 48.3 19.7 19.4 22.3 8.3 10.2 8.6
Native Hawaiian and Other Pacific Islander only — * * — * * — * * — * *
2 or more races — 15.2 18.0 — 40.8 41.2 — 22.2 23.5 — 21.8 17.3
Hispanic Origin and race3,4
Hispanic or Latino 24.9 26.2 27.0 42.3 44.3 40.2 20.3 19.2 20.7 12.5 10.3 12.0
Mexican 28.9 30.2 31.4 40.8 43.0 39.2 18.5 18.2 19.6 11.8 8.7 9.8
Not Hispanic or Latino 15.4 16.2 15.0 46.7 46.0 46.5 24.0 23.9 25.0 13.9 13.9 13.5
White only 14.7 15.5 14.3 46.6 46.0 46.4 24.4 24.5 25.4 14.3 14.1 13.9
Black or African American only 16.9 18.4 16.4 46.1 46.2 46.4 23.1 21.9 24.0 13.8 13.5 13.1
Respondent-assessed health status3
Fair or poor 7.8 9.8 9.0 23.3 25.9 22.1 29.0 24.3 27.7 39.9 40.1 41.3
Good to excellent 17.2 18.1 17.3 48.4 47.7 48.0 23.3 23.2 24.3 11.1 11.0 10.5
Poverty status3,5
Poor 20.3 21.5 21.7 37.1 39.2 37.2 22.7 21.3 23.4 19.9 18.0 17.7
Near poor 19.9 22.2 20.4 42.8 41.6 41.4 21.8 21.5 22.9 15.5 14.7 15.3
Nonpoor 14.0 14.9 14.0 48.0 47.0 47.4 25.0 25.0 25.8 13.0 13.1 12.8
Hispanic origin and race and poverty status3,4,5
Hispanic or Latino:
Poor 30.6 31.2 34.3 33.8 38.2 32.7 20.0 18.7 18.1 15.6 11.8 14.9
Near poor 29.1 30.2 28.9 39.0 42.1 39.3 20.9 17.5 20.2 11.0 10.1 11.6
Nonpoor 18.7 21.0 19.9 48.6 46.8 44.6 20.3 21.9 24.7 12.3 10.2 10.8
Not Hispanic or Latino:
White only: 16.3 17.2 16.2 37.7 38.9 38.7 24.0 23.3 26.4 22.1 20.7 18.8
Poor 17.1 19.8 17.1 43.7 40.8 41.3 22.3 23.3 24.1 17.0 16.1 17.6
Near poor 13.2 14.0 13.1 47.6 46.9 47.5 25.7 25.5 26.1 13.4 13.6 13.3
Nonpoor
Black or African American only:
Poor 17.8 18.0 17.3 37.4 39.9 38.1 23.3 23.1 24.0 21.5 19.0 20.5
Near poor 18.9 19.9 18.1 43.0 44.0 44.9 23.4 20.5 23.4 14.7 15.6 13.6
Nonpoor 15.6 16.3 14.6 50.5 48.2 47.4 23.3 23.7 26.6 10.6 11.8 11.4

According to the Centers for Medicare and Medicaid Services, in the first quarter of fiscal year 2004 about 4.1 million children were enrolled in SCHIP.

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