Sexual Violence in Adolescent Dating Relationships

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Declining Access of Adolescents and Young Adults
to Both Public and Private Sources of Health
Insurance
Niev J. Duffy, PhD Mount Sinai Adolescent Health
Center The Mount Sinai Medical Center New York,
New York
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Objective
To explore the impact of the restructuring of
health care markets on the health insurance
status of adolescents and young adults, taking
into consideration changes in both public and
private sources of insurance. To evaluate the
potential public health implications of these
trends.
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Methods
The author analyzed data from eleven years of the
March Supplement of the Current Population Survey
in order to identify trends in Medicaid and
private insurance coverage.
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Introduction

• Health insurance coverage among children fell
  dramatically during the recession of the early
  1990s. Between 1994 and 1998 levels of private
  insurance coverage among children recovered only
  slightly.

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A Few Words of Caution

• Data before and after 1994 are not directly
  comparable because of a change in the ordering of
  CPS questions that dramatically increased
  reporting of private insurance among children.
• Data before and after 1999 are not directly
  comparable due to a change in the composition of
  CPS questions that dramatically increased
  reporting of private health insurance among
  children. Thus the apparent rise in insurance in
  the following diagrams in 1999 and 2000 is
  largely or entirely due to coding changes.

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Medicaid

• Medicaid coverage among children rose until 1995,
  and then began a downward slide.

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Uninsurance among Children

• As a consequence of these two trends uninsurance
  among children rose both during the recession of
  the early 1990s and during the long economic
  recovery. The apparent decline in rates of
  uninsured between 1998-2000 was largely or
  entirely due to changes in the structure of
  Survey questions and therefore does not
  necessarily reflect improvements in the health
  insurance status of children.

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Health Insurance Status of Parents and Children

• The health insurance status of children is
  largely determined by that of their parents.
  Declining private employer provided health
  insurance among parents, particularly those
  working full-time year-round leads to an erosion
  of coverage among children. Younger children are
  less likely to have private coverage because
  their parents, who are also younger, are less
  likely to have coverage.

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Rates of Private Insurance All Among Children
Aged 0-18
Source Authors Calculations Using March
Supplement of the Current Population Survey,
1990-2001
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RESULTS

• Declining access in the U.S. to both public and
  private sources of health insurance among
  children and young adults.
• Declines in rates of private employer provided
  coverage among fulltime year-round workers during
  1990s sharpest for adults in their peak
  childbearing years, 19-29.
• Younger children/younger parents have lower rates
  of private insurance.

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RESULTS

• Recent partial recovery of private health
  insurance benefits among children is due to
  extraordinarily high rates of fulltime labor
  force participation among spouses in households
  with children.
• Growing gap in private health care coverage
  between older adolescents/young adults and other
  age groups.

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IMPLICATIONS FOR COMMUNITY HEALTH

• The rising share of uninsured among adolescents
  imposes a strain on the resources of health care
  institutions providing services to this
  population, at a time when cost-shifting is
  increasingly difficult.
• Financial difficulties are worsened by cuts in
  health care subsidies and declining reimbursement
  rates, as well as declining funding for
  reproductive health care.

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IMPLICATIONS FOR COMMUNITY HEALTH

• The current economic downturn is likely to
  accelerate the decline in private health
  insurance leading to rising rates of
  uninsurance.
• The loss of Medicaid coverage may accelerate as
  recipients of public assistance reach the 5 year
  welfare reform limit.

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IMPLICATIONS FOR COMMUNITY HEALTH

• Ultimately, continued financial difficulties lead
  to declining quality of care or denial of
  services to the uninsured.
• Rising uninsurance leads to rising demands on the
  resources of Medicaid and CHIP.
• Financially troubled health care institutions cut
  community services.