Expanding Health Insurance To Families Seen As Efficient Strategy To Cover Millions Of Uninsured

As a new administration and Congress consider ways to lower the number of uninsured Americans, a new study supported by The Commonwealth Fund reveals that expanding existing private and public coverage to entire families would reach millions of uninsured efficiently. In an article published today in Health Affairs, Patterns of Insurance Coverage Within Families With Children, Karla Hanson of the New School University analyzes data representing over 32 million U.S. families with children. Although in more than three-quarters of families all members are insured, in a surprisingly high proportion of families—one of seven (14%Ôonly one or some of the members are insured, but not all. Hanson argues that targeting these four and a half million families for health insurance coverage provides an ideal opportunity to make an impact on the problem of the uninsured.

"These families are already connected with the system of health insurance, whether through employer coverage or public programs such as Medicaid," said Karen Davis, president of The Commonwealth Fund. "It makes sense to capitalize on these existing links." Partially Uninsured Families Are Most Likely to Be Low-Income Working Families
Hanson finds the following:

• In 1.6 million families, the parent (or parents in a two-parent family) are covered while the children are uninsured. These are most likely families in which a parent has coverage through his or her job but cannot afford higher premiums to cover the entire family.
• In 1.3 million families, the children are insured but the parent (or parents in a two-parent family) are uninsured. The majority (65%) of these are low-income families in which the children are covered by Medicaid but parents are ineligible.
• The remaining 1.6 million families consist of a variety of arrangements: either one parent is uninsured and the other parent and children are insured, or some children are insured and some are not. In the latter case, families are more likely to have a sick or disabled child than in the other partially uninsured families.

Proposals to Expand Coverage
Based on her findings, Hanson proposes three key routes to family coverage:

• Subsidies could be provided to help low-income parents pay the higher premiums for family coverage. This would be less costly than public coverage for children.
• Federal Medicaid and state Child Health Insurance Program funds could be made more flexible so that older children and low-income parents could be covered.
• Medicaid coverage for disabled persons could be expanded to uninsured family members, who often face financial burdens because of their role as caregiver.

Hanson points out that expanding health insurance to provide whole-family coverage can simplify complex health insurance arrangements resulting from a patchwork system of public and private programs. An important added benefit is that families in which all members are covered have better access to health care and improved continuity of care.