• Among families with no health insurance the entire year and incomes below the poverty level, more than one in four have out-of-pocket expenses that exceed 5 percent of income; 4 percent of all uninsured families have expenses that exceed 20 percent of annual income.

Family Well-Being and Health Insurance

  • Extension of publicly supported health insurance to low-income uninsured parents is associated with increased enrollment among children.

  • Uninsured parents have poorer health, have poorer access to the health care system, are less satisfied with the care they receive when they gain access, and are more likely to have negative experiences around bill collection compared with insured parents.

  • The health of one family member can affect the health and well-being of other family members. In particular, the health of parents can play an important role in the well-being of their children.

Health-Related Outcomes for Children, Pregnant Women, and Newborns

  • Uninsured children have less access to health care, are less likely to have a regular source of primary care, and use medical and dental care less often compared with children who have insurance. Children with gaps in health insurance coverage have worse access than do those with continuous coverage.

  • Previously uninsured children experience significant increases in both access to and more appropriate use of health care services following their enrollment in state-sponsored health insurance expansions.

  • Lower-income, minority, non-citizen, or uninsured children consistently have worse access and utilization than do children with none of these characteristics. These factors overlap to a large extent. However, each exerts its own independent effect on access and utilization.

  • Uninsured children often receive care late in the development of a health problem or do not receive any care. As a result, they are at higher risk for hospitalization for conditions amenable to timely outpatient care and for missed diagnoses of serious and even life-threatening conditions.

  • Undiagnosed and untreated conditions that are amenable to control, cure, or prevention can affect children’s functioning and opportunities over the course of their lives. Such conditions include iron deficiency anemia, otitis media, asthma, and attention deficit–hyperactivity disorder.

  • Uninsured women receive fewer prenatal care services than their insured counterparts and report greater difficulty in obtaining the care that they believe they need. Studies find large differences in use between privately insured and uninsured women and smaller differences between uninsured and publicly insured women.

  • Uninsured women and their newborns receive, on average, less prenatal care and fewer expensive perinatal services. Uninsured newborns are more likely to have low birthweight and to die than are insured newborns. Uninsured women are more likely to have poor outcomes during pregnancy and delivery than are women with insurance. Studies have not demonstrated an improvement in maternal outcomes related to health insurance alone.

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