Previous studies (1984-1995) of adolescent health insurance have shown
little change in the proportion with coverage. Federally mandated expansions
in Medicaid were offset by declines in private coverage. Further expansions
of Medicaid and implementation of the State Children's Health Insurance Program
(SCHIP) have opened new avenues for increasing coverage rates.
To assess the current health insurance status of adolescents, the demographic
and socioeconomic correlates of insurance coverage, and document recent changes
in public and private coverage rates.
Design, Setting, and Participants
We analyzed data on 12 995 adolescents aged 10 to 18 years, who
had been included in the 2002 National Health Interview Survey. We conducted
multivariate analyses to assess the independent association of age, sex, race,
poverty status, family structure, family size, and region on the likelihood
of having insurance coverage. Results are compared with previously published
findings on adolescent health insurance coverage spanning 1984 to 1995.
Main Outcome Measure
Insurance coverage for adolescents.
An estimated 12.2% of adolescents were uninsured in 2002, which is a
decrease from 14.1% in 1995 (P<.003). The decrease
occurred entirely because of an expansion of public coverage and is concentrated
among children in poor (<100% of the federal poverty level) and near-poor
(100%-199% of the federal poverty level) families. A substantial decrease
in the differences between poor and higher-income groups occurred between
1995 and 2002 due to gains in coverage for adolescents in poor and near-poor
families and losses in coverage among those in middle- and upper-income families
(≥200% of the federal poverty level). Specifically, the proportion of adolescents
in poor families without coverage declined from 27.4% in 1995 to 19.7% in
2002 (P<.001). The proportion of adolescents in
near-poor families without coverage declined from 24.8% in 1995 to 19.2% in
2002 (P<.002). In contrast, the proportion of
adolescents in middle- and higher-income families without insurance increased
from 4.1% in 1995 to 6.3% in 2002 because availability of insurance through
the private market declined (P<.001).
A modest but significant reduction in the percentage of adolescents
without insurance has occurred since 1995, largely as a result of expansions
in public coverage. An even larger reduction in the proportion of adolescents
without coverage would have occurred, if not for a reduction in private coverage
for adolescents in middle- and higher-income families.