Adequate Insurance - Children in United States

United States

Continuous and adequate insurance coverage facilitates consistent access to preventive and acute health care services. Nearly one-third of children in the United States are underinsured — meaning that although they have health insurance, their coverage does not adequately cover a sufficient portion of their care or health expenses. Compared with adequately insured children, those who are underinsured or uninsured have health care disadvantages, including: 

• Delayed or forgone care.
• Lack of a personal doctor.
• Difficulty obtaining needed specialist care.
• Difficulty receiving needed referrals, care coordination and family-centered care — the components of a medical home.

Being underinsured can leave a family vulnerable to the financial risk of medical expenses resulting from illness or disease. A family whose health insurance has a high deductible (meaning they must spend a large amount on health care before their insurance benefits kick in) or low coverage (meaning they pay more to access needed benefits) may struggle to pay their bills. These characteristics contribute to high out-of-pocket costs and drive rising childhood underinsurance rates, according to a 2021 study. The study found that more Americans with health insurance still cannot afford medical care.

According to America's Health Rankings analysis, populations more likely to have adequate health insurance include:

• Children with a caregiver who graduated from high school compared with children who have a caregiver with a college degree, some post-high school education or less than a high school education.
• Children without special health care needs compared with children with special health care needs.
• Multiracial and Black children compared with Hispanic, Asian and white children.

Additional research shows that children younger than 6 are more likely to have adequate health insurance compared with children age 12 and older.

Options to improve insurance adequacy among children include expanding or enhancing Medicaid and the Children’s Health Insurance Plan (CHIP). The American Medical Association (AMA) recommends expanding eligibility for premium tax credits to cover those with incomes up to five times the federal poverty level while maintaining a structure that provides more aid for those with lower incomes. Additionally, the AMA suggests enhanced premium tax credits for young adults, which would incentivize participation in the health insurance market, increase coverage and drive down costs for everyone.

The Commonwealth Fund has an interactive map of actions each state is taking to improve access to adequate health insurance.

Increasing the proportion of Americans with health insurance is a leading health indicator for Healthy People 2030. The U.S. Department of Health and Human Services has a strategic goal to improve the availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP and Medicaid.

Fiscal Year 2025 Annual Performance Plan and Report. U.S. Department of Health and Human Services, March 2024. https://www.hhs.gov/sites/default/files/fy2025-performance-plan.pdf.

Kogan, Michael D., Paul W. Newacheck, Stephen J. Blumberg, Reem M. Ghandour, Gopal K. Singh, Bonnie B. Strickland, and Peter C. van Dyck. “Underinsurance among Children in the United States.” New England Journal of Medicine 363, no. 9 (August 25, 2010): 841–51. https://doi.org/10.1056/NEJMsa0909994.

Yu, Justin, James M. Perrin, Thomas Hagerman, and Amy J. Houtrow. “Underinsurance Among Children in the United States.” Pediatrics 149, no. 1 (January 1, 2022): e2021050353. https://doi.org/10.1542/peds.2021-050353.