Adequate Insurance - Children in Wisconsin

Wisconsin

Maintaining continuous and adequate insurance is essential for a child’s health. However, nearly one-third of children in the United States are underinsured, meaning they do not have adequate health insurance. Compared with adequately insured children, those who are underinsured have more health 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.

Being underinsured can leave a family unprotected from the financial risk of medical expenses due to illness or disease. A family whose insurance has a high deductible or low coverage may struggle to pay their bills. This type of insurance inadequacy is a main driver of rising childhood underinsurance rates, according to a 2021 study. The study found that an increasing number of Americans with health insurance still cannot afford medical care due to unreasonably high out-of-pocket costs.

According to data from the National Survey of Children’s Health, populations more likely to have adequate health insurance include:

• Children under age 6 compared with children age 12 and older.
• Non-Hispanic Black children compared with Hispanic and Asian children. 
• Children without special health care needs.
• Children who have public health insurance compared with privately insured children.

Options to improve the adequacy of insurance among children include expanding Medicaid and/or the Children’s Health Insurance Plan (CHIP), or creating a national single-payer child health insurance plan. The American Medical Association recommends expanding eligibility for premium tax credits up to 500% of the federal poverty level, maintaining a premium tax credit structure that is inversely related to income and providing young adults with enhanced premium tax credits.

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

Adequate insurance among children is a National Performance Measure of the Title V Maternal & Child Health Services Block Grant program.

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.

Lavarreda, Shana Alex, E. Richard Brown, and Claudie Dandurand Bolduc. “Underinsurance in the United States: An Interaction of Costs to Consumers, Benefit Design, and Access to Care.” Annual Review of Public Health 32, no. 1 (March 18, 2011): 471–82. https://doi.org/10.1146/annurev.publhealth.012809.103655.

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.