Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households' insurance coverage.

Scott R Sanders,Michael R Cope,Wesley Jeffery,Paige N Park,Jorden E Jackson,Emma Sacks

doi:10.1371/journal.pone.0222387

Abstract

In order to gain insights into how the effects of the uneven adoption of Medicaid expansion varies across the rural/urban spectrum and between racial/ethnic groups in the United States, this research used the fertility question in the 2011–2015 American Community Survey to link infants’ records to their mothers’ household health insurance status. This preliminary exploration of the Medicaid expansion used logistic regression to examine the probability that an infant will be born without health insurance coverage. Overall, the states that adopted Medicaid expansion improved the health insurance coverage for households with infants. However, rural households with infants report lower percentages of coverage than urban households with infants. Furthermore, the rural/urban gap in health insurance coverage is wider in states that adopted the Medicaid expansion. Additionally, Hispanic infants remain significantly less likely to have health insurance coverage compared to Non-Hispanic White infants. Understanding infant health insurance coverage across ethnic/racial groups and the rural/urban spectrum will become increasingly important as the U.S. population transitions to a minority-majority and also becomes more urban. Although not a perfect solution, our findings showed that the Medicaid expansion of health insurance coverage had a mainly overall positive effect on the percentage of U.S. households with infants who have health insurance coverage.

Highlights

In this paper is a preliminary exploration of how the uneven expansion of Medicaid affects racial/ethnic health insurance coverage across the rural/urban spectrum in the United States
Whether or not Medicaid expanded in the state of household produced significantly (p < .01) different levels of infant households without health insurance, in which approximately 13% of infants were in households without insurance in the Medicaid expansion states and approximately 23% were in households without insurance in non-expansion states
These racial groups were much lower than the percentage of Native Americans (29.5%) and Other/Mixed (28.8%) infant households without insurance

Summary

Introduction

In this paper is a preliminary exploration of how the uneven expansion of Medicaid affects racial/ethnic health insurance coverage across the rural/urban spectrum in the United States. Unlike previous studies that have examined health insurance coverage in the United States [1, 2, 3], we emphasized only those households with infants. It is essential to understand the settings in which infants are born because previous research has shown that access to Medicaid improves health outcomes [4] and their household environment has long-term implications for their educational achievement, positive developmental trajectories, and transitions to productive adult roles [5, 6]. Racial/ethnic and rural/urban disparities in infant households’ health insurance The absence of basic and essential healthcare in utero or during early formative stages can create barriers that adversely affect health and cognitive

Results

Discussion

Conclusion