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Health Insurance Coverage of Children Under Age 19: 2008 and 2009

Written by:
Report Number ACSBR/09-11


Health insurance coverage, whether private or public, improves children’s access to health care services and the regularity with which children receive medical care. This improved access to care leads to better health for insured children compared to uninsured children.1

Insured children are either covered by private health insurance as dependents on a parent’s or guardian’s plan or through public coverage available to eligible low-income children. Children’s health insurance coverage is susceptible to changes in adults’ insurance coverage status as well as changes in a child’s eligibility for public programs.

Between 2008 and 2009, changes in children’s health insurance coverage type concurred with reduced access to private insurance and increased eligibility for public coverage. There were 9.4 million families with at least one unemployed member in 2009, up from 6.1 million in 2008.2 This increase suggests decreased access to private insurance for parents and children.3 The increase in the poverty rate for children under age 18, from 18.3 percent in 2008 to 20.0 percent in 2009, indicates that more children were eligible for public coverage.

Two federal laws increased access to public coverage in 2009. First, the federal government reauthorized the Children’s Health Insurance Program—a program designed to provide health insurance coverage to uninsured children in families with income-levels above standards to qualify for Medicaid. The reauthorization took effect in April of 2009 and included funds for outreach and enrollment grants as well as provisions to remove barriers to enrollment. Second, the federal government passed the American Recovery and Reinvestment Act of 2009, which included funds to help states maintain Medicaid services for current enrollees and to defray costs associated with new enrollment from October 2008 through December 2010.4 It is likely that these two Acts boosted enrollment in public programs shortly after the provisions in the Acts took effect.5,6

This report presents data on health insurance coverage of children under age 19 in the 2008 and 2009 American Community Surveys (ACS).7 The data presented in this report are for the civilian noninstitutionalized population, which excludes active-duty military and persons in prisons and nursing homes.

1 Institute of Medicine, Health Insurance Is a Family Matter, The National Academies Press, Washington DC, 2002.
2 Bureau of Labor Statistics, U.S. Department of Labor, “Employment Characteristics of Families—2009,” June 10, 2010, <www.bls.gov/news.release /famee.nr0.htm> (August 10, 2010).
3 Gerry L. Fairbrother et al., “The Impact of Parental Job Loss on Children’s Health Insurance Coverage,” Health Affairs, vol. 29, no. 7, 2010.
4 Kaiser Commission on Medicaid and the Uninsured, “American Recovery and Reinvestment Act (ARRA): Medicaid and Health Care Provisions,” March 4, 2009, <www.kff.org/medicaid/7872.cfm> (August 10, 2010).
5 Vernon K. Smith, et al., “The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession,” September 2009, <www.kff.org /medicaid/7985.cfm> (August 30, 2010).
6 Vernon K. Smith, et al., “CHIP Enrollment June 2009: An Update on Current Enrollment and Policy Directions,” April 2010, <www.kff.org/ medicaid/7642 .cfm> (August 30, 2010).
7 Data for children under 19 are presented because both Medicaid and the Children’s Health Insurance Program are available to eligible children under 19.


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