Insurance Gaps Among Vulnerable Children in the United States,

Objective—To quantify the number of children who experience gaps in insurance coverage and to determine whether vulnerable subgroups of children experience noteworthy lapses in insurance coverage. Methods—We analyzed nationally representative data from 24 149 children sampled in the 1999– 2001 Medical Expenditure Panel Survey linked to the 1997–1999 National Health Interview Survey. Vulnerable subgroups of children included children with chronic conditions, those from ethnic/racial minorities, and those living in poverty. On the basis of cumulative annual monthly insurance coverage status, each child fell into 1 of 3 groups: continuous coverage, uninsured, or gaps in coverage. Using SAS-callable SUDAAN, we conducted multivariate ordinal logistic regression model to quantify the likelihood of having gaps in coverage for vulnerable subgroups of children. Results—From 1999 to 2001, we found that> 9 million American children annually had gaps in coverage and that 5 to 6 million children annually were uninsured for the entire year. Sixty percent of children experienced gaps of at least 4 months, and> 40 % of all publicly and privately insured children had coverage gaps. After accounting for relevant covariates, children with chroni