Parental Health Insurance Research Articles

The effect of fine particulate matter (PM2.5) pollution on health inequality: an intergenerational perspective.

Air pollution poses a serious challenge to public health and simultaneously exacerbating regional & intergenerational health inequality. This research introduces PM2.5 pollution into the intergenerational health transmission model, and estimates its impact on health inequality in China using Ordered Logit Regression (OLR) and Multi-scale Geographically Weighted Regression (MGWR) model. The results indicate that PM2.5 pollution exacerbate the intergenerational health inequality, and its impacts show inconsistency across family income levels, parental health insurance status, and area of residence. Specifically, it is more difficult for offspring in low-income families to escape from the influence of unhealthy family to become upwardly mobile. Additionally, this health inequality is more significant in households in which at least one parent does not have health insurance. Moreover, the intergenerational solidification caused by PM2.5 pollution is higher in the east and lower in the west. Both the PM2.5 level and solidification effect are high in Beijing-Tianjin-Hebei region, Yangtze River Delta region and central areas of China, which is the focus of air pollution management. These findings suggest that more emphasis should be placed on family-based health promotion. In areas with high PM2.5 pollution levels, resources, subsidies and air pollution protection should be provided for less healthy families with lower incomes and no health insurance.

An observational study of health insured visits for children following Medicaid eligibility expansion for adults among a linked cohort of parents and children.

Despite its focus on adults, the Affordable Care Act (ACA) Medicaid expansion led to increased health insurance enrollment for children in the United States. Previous studies looked at parent and child insurance changes separately, or used a single survey response item to understand changes in health insurance for parents and children. It is, however, important to understand the connection between parent and child insurance changes together (not individually) using data sources that account for insurance over time. Therefore, to understand the association of parental health insurance on their children’s coverage, leveraging a cohort of linked families seen in community health centers (CHCs), we used electronic health records to link a cohort of parents and children with ≥1 visit to a CHC in a Medicaid expansion state pre- (1/1/2012–12/31/2013) and ≥1 visit post-ACA (1/1/2014–12/31/2018) and determined primary payer type for all visits. This observational, cohort study assessed the rate of insured visits for children pre- to post-ACA across four parental insurance groups (always insured, gained Medicaid, discontinuously insured, never insured) using Poisson mixed effects models. We included 335 CHCs across 7 United States. Insurance rates were highest (~95 insured visits/100 visits) for children of parents who were always insured; rates were lowest for children of parents who were never insured (~83 insured visits/100 visits). Children with a parent who gained Medicaid had 4.4% more insured visits post- compared to pre-ACA (adjusted relative rates = 1.044, 95% confidence interval: 1.014, 1.074). When comparing changes from pre- to post-ACA between parent insurance groups, children’s insured visit rates were significantly higher for children of parents who gained Medicaid (reference) compared to children of parents who were always insured (adjusted ratio of rate ratio: 0.963, confidence interval: 0.935–0.992). Despite differences in Medicaid eligibility for children and adults, health insurance patterns were similar for linked families seen in CHCs. Findings suggest consideration should be paid to parent health insurance options when trying to increase children’s coverage.

How does losing health insurance affect disability claims? Evidence from the Affordable Care Act's dependent care mandate.

We estimate the impacts of losing access to parental health insurance on Supplemental Security Income (SSI) participation, focusing on the age-26 limit for dependent coverage. We analyze the age pattern of SSI claims to develop counterfactual predictions that assume no change in access to insurance. Relative to this prediction, we find a 3.4% spike in SSI applications in the months immediately surrounding the 26th birthday, along with a slightly smaller increase in awards. These claims are primarily motivated by losing coverage; there might be more direct ways to address unmet insurance needs without also increasing reliance on cash payments.

Is the ACA bringing the family back together (for tax purposes)? Investigating the dependent coverage mandate effect on dependent tax exemptions

A 2010 national policy change due to the Affordable Care Act allowed dependent children to remain on parental health insurance policies until age 26. Evidence shows the mandate increased insurance coverage among affected young adults and also increased premiums for family health insurance policies. In this paper, we investigate the use of dependent tax exemptions as a mechanism families could use to pay for increased costs associated with expanded coverage. Using data on households from the Medical Expenditure Panel Survey, we use a difference-in-difference methodology comparing changes in the likelihood of being claimed as a dependent on a tax return for the 19–25 year olds affected by the coverage mandate compared to 16–18 year olds that were unaffected. We find a significant increase in dependent tax exemptions among 19–25 year olds following implementation of the dependent coverage mandate. Family income gains from switching an exemption from a young adult child to the parent would shift a substantial portion of young adult insurance coverage costs (ultimately medical costs) to other taxpayers. Though we point to family health insurance cost as a likely driver of the increased dependent tax exemptions, we cannot rule out a role for other outcomes also affected by the mandate, including labor market changes among 19–25 year olds. We further compare the overall social costs and benefits of the mandate and show that absent significant health improvement to date, welfare gains likely depend on the positive contribution of young adults to insurance pools in terms of lower average costs.

The Role of Public and Private Insurance Expansions and Premiums for Low-income Parents: Lessons From State Experiences.

Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Cross-sectional analysis of the 2000-2013 March supplements to the Current Population Survey, with data from the Medical Expenditure Panel Survey-Insurance Component and the Area Resource File. Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-in-difference modeling. All analyses controlled for household, parent, child, and local area characteristics that could affect insurance status. Expansions increased parental coverage by 2.5 percentage points, and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents' insurance. Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Effects of dependent coverage mandate on household precautionary savings: Evidence from the 2010 Affordable Care Act

This article examines the effects of the health insurance coverage mandate for young adults on household precautionary savings by focusing on the Affordable Care Act (ACA) of 2010. The ACA dependent coverage mandate allows young adults to remain on their parents’ health insurance plans until their 26th birthday. Using the Survey of Income and Program Participation data, I find that the ACA mandate reduced precautionary savings for households with both parental employer-sponsored health insurance and dependent children aged 19–25 years. These households significantly reduced liquid assets by $897 after ACA, but they did not reduce savings in tax-deferred accounts or real estate assets.

Effects of the Affordable Care Act's Dependent Coverage Mandate on Household Financial Portfolio

This article examines the effects of the health insurance coverage mandate for dependents on household financial portfolio decisions by focusing on the Affordable Care Act (ACA) of 2010. The act allows young adults to remain on their parents’ health insurance plans until their 26th birthday. Using the Survey of Income and Program Participation data, the author finds that the ACA dependent coverage mandate significantly increased the share of stocks by 4.2 percentage points for households having both parental employer-sponsored health insurance and dependent children aged 19-25 years. The mediation analysis suggests that the ACA mandate had a positive effect on shares of stocks through reduction in medical expenditures. However, the mandate had no significant effect on reduction in shares of bonds or assets in interest-bearing accounts.

Change, Challenge, and Opportunity: Psychiatry in the Age of Health Care Reform

Change, Challenge, and Opportunity: Psychiatry in the Age of Health Care Reform

Does the availability of parental health insurance affect the college enrollment decision of young Americans?

The present study examines whether the college enrollment decision of young individuals (student full-time, student part-time, and non-student) depends on health insurance coverage via a parent's family health plan. Our findings indicate that the availability of parental health insurance can have significant effects on the probability that a young individual enrolls as a full-time student. A young individual who has access to health insurance via a parent can be up to 22% more likely to enroll as a full-time student than an individual without parental health insurance. After controlling for unobserved heterogeneity this probability drops to 5.5% but is still highly significant. We also find that the marginal effect of the availability of parental health insurance has a larger effect on older students between ages 21 and 23. We provide a brief discussion about possible implications of the Affordable Care Act of 2010 in this context.

Does the Availability of Parental Health Insurance Affect the College Enrollment Decision of Young Americans?

The present study examines whether the college enrollment decision of young individuals (student full-time, student part-time, non-student) depends on health insurance coverage via a parent’s family health plan. Our findings indicate that the availability of parental health insurance has significant effects on the probability that a young individual enrolls as a full-time student. A young individual who has access to health insurance via a parent is up to 22 percent more likely to enroll as a full-time student than an individual without parental health insurance. After controlling for unobserved heterogeneity this probability drops to 5.5-6.5 percent but is still highly significant. We also find that the marginal effect of the availability of parental health insurance has a larger effect on older students between ages 21-23. We provide a brief discussion about possible implications of the Affordable Care Act of 2010 in this context.

Does Health Insurance Continuity Among Low-income Adults Impact Their Children’s Insurance Coverage?

Parent's insurance coverage is associated with children's insurance status, but little is known about whether a parent's coverage continuity affects a child's coverage. This study assesses the association between an adult's insurance continuity and the coverage status of their children. We used data from a subgroup of participants in the Oregon Health Care Survey, a three-wave, 30-month prospective cohort study (n=559). We examined the relationship between the length of time an adult had health insurance coverage and whether or not all children in the same household were insured at the end of the study. We used a series of univariate and multivariate logistic regression models to identify significant associations and the rho correlation coefficient to assess collinearity. A dose response relationship was observed between continuity of adult coverage and the odds that all children in the household were insured. Among adults with continuous coverage, 91.4% reported that all children were insured at the end of the study period, compared to 83.7% of adults insured for 19-27months, 74.3% of adults insured for 10-18months, and 70.8% of adults insured for fewer than 9months. This stepwise pattern persisted in logistic regression models: adults with the fewest months of coverage, as compared to those continuously insured, reported the highest odds of having uninsured children (adjusted odds ratio 7.26, 95% confidence interval 2.75, 19.17). Parental health insurance continuity is integral to maintaining children's insurance coverage. Policies to promote continuous coverage for adults will indirectly benefit children.

Opportunities for outreach: Medicaid participation among children in Ohio.

This research seeks to determine individual and household differences between children who enrolled in Medicaid and the Children's Health Insurance Program (CHIP) and children who did not. In addition, the study investigates the specific reasons that families provided for not enrolling their children in Medicaid/CHIP. Data from the 1998 Ohio Family Health Survey were used to determine individual and household differences between children who were enrolled in Medicaid and CHIP and children who were not. Findings show that lower household income, parental unemployment, parental health insurance, and younger (child) age, were associated with greater participation in Medicaid/CHIP among eligible children in Ohio. Children in poorer health and those who resided in counties with higher levels of expenditures on outreach were also more likely to be enrolled. Findings from this study suggest a substantial need to increase awareness about program eligibility and to develop creative outreach strategies aimed at reaching nontraditional Medicaid families.

Do medical out-of-pocket expenses thrust families into poverty?

This paper estimates the impact of medical out-of-pocket expenses on families' well-being using the Survey of Income and Program Participation. Medical out-of-pocket expenses include the out-of-pocket costs from medical services and the family's share of health insurance premiums. Demographic characteristics, insurance status, and medical usage of the family are analyzed to determine which characteristics are most likely to impoverish a family. Families impoverished because of medical out-of-pocket expenses are far more likely to have older heads of the family, at least one family member in poor health, or some adults without health insurance. Families without at least one person who worked full time for the entire year were also likely to be impoverished. However, children in the family had little effect on the probability that the family became impoverished. This odd result is probably due to the high correlation between parental health insurance coverage and the health insurance coverage of their children.