Uninsured Children in Hawaii

Hawaii

Health insurance is critical for ensuring that children receive the medical care they need to achieve and maintain good health. Children with health insurance coverage are more likely to have a usual source of care and less likely to delay or forgo necessary medical care because of cost. 

When compared with privately insured children, uninsured children have more health disadvantages, including:

• More hospitalizations.
• Higher in-hospital mortality rates.
• Less stable and frequent preventive care. 
• Lower rates of vaccine coverage. 

In 2022, 5.4% of children ages 0-19 in the United States were uninsured, while  61.8% were privately insured and 36.1% had coverage through public plans such as Medicaid, the Children’s Health Insurance Program (CHIP) and other government-sponsored health plans.

The uninsured rate is higher among:

• American Indian/Alaska Native, Native Hawaiian or Other Pacific Islander and Hispanic children compared with non-Hispanic white, Black and Asian children.
• Children from lower-income families compared with those from higher-income families. High cost is often cited as the reason for lack of coverage.
• Children living in states that have not expanded Medicaid compared with those living in Medicaid expansion states.

Public programs such as Medicaid and CHIP have made significant strides in increasing access to and quality of care and improving health status for low-income children. States that have expanded Medicaid eligibility have substantially improved children's insurance rates. To date, 10 states have not expanded Medicaid coverage. 

The CDC offers a fact sheet on how schools can help children get health insurance. This includes identifying uninsured children at the beginning of the school year and helping students and their families obtain coverage. 

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.

Abdullah, Fizan, Yiyi Zhang, Thomas Lardaro, Marissa Black, Paul M. Colombani, Kristin Chrouser, Peter J. Pronovost, and David C. Chang. “Analysis of 23 Million US Hospitalizations: Uninsured Children Have Higher All-Cause in-Hospital Mortality.” Journal of Public Health 32, no. 2 (June 1, 2010): 236–44. https://doi.org/10.1093/pubmed/fdp099.

Hill, Holly A., David Yankey, Laurie D. Elam-Evans, Michael Chen, and James A. Singleton. “Vaccination Coverage by Age 24 Months Among Children Born in 2019 and 2020 — National Immunization Survey-Child, United States, 2020–2022.” MMWR. Morbidity and Mortality Weekly Report 72, no. 44 (November 3, 2023): 1190–96. https://doi.org/10.15585/mmwr.mm7244a3.

Keisler-Starkey, Katherine, and Lisa N. Bunch. “Health Insurance Coverage in the United States: 2021.” Current Population Reports. U.S. Government Publishing Office, Washington, DC: U.S. Census Bureau, September 2022. https://www.census.gov/content/dam/Census/library/publications/2022/demo/p60-278.pdf.

Kreider, Amanda R., Benjamin French, Jaya Aysola, Brendan Saloner, Kathleen G. Noonan, and David M. Rubin. “Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families.” JAMA Pediatrics 170, no. 1 (January 1, 2016): 43. https://doi.org/10.1001/jamapediatrics.2015.3028.

Kusma, Jennifer D., Jean L. Raphael, James M. Perrin, Mark L. Hudak, James M. Perrin, Lisa Chamberlain, Jennifer D. Kusma, et al. “Medicaid and the Children’s Health Insurance Program: Optimization to Promote Equity in Child and Young Adult Health.” Pediatrics 152, no. 5 (November 1, 2023): e2023064088. https://doi.org/10.1542/peds.2023-064088.

Tolbert, Jennifer, Kendal Orgera, Natalie Singer, and Anthony Damico. “Key Facts about the Uninsured Population.” Issue Brief. KFF, December 19, 2022. https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.