Health Insurance Coverage of Children, 2007

Health Insurance Coverage of Children, 2007

Order Code 97-975
Updated September 2, 2008
Health Insurance Coverage of Children, 2007
Chris L. Peterson and April Grady
Domestic Social Policy Division
Summary
Based on data from the Census Bureau’s Current Population Survey (CPS), 8.9
million children under age 19 were uninsured in 2007 (11.3%), a statistically significant
decline compared to 9.4 million in 2006 (12.1%). This decline occurred because of a
significant increase in public coverage, from 26.8% in 2006 to 27.9% in 2007. The
percentage of children with employment-based health insurance (61%) was unchanged.
Only 7.5% of non-Hispanic white children were uninsured in 2007, compared with
20.7% of Hispanic children. Compared to 2006, black and Hispanic children
experienced significant increases in 2007 in rates of public coverage, resulting in a drop
in their uninsurance rates. Children whose parents worked in a small firm were much
more likely to be uninsured (22% in firms with less than 10 workers) than those whose
parents worked in a large firm (5% in firms with 1,000 or more workers). Among the
8.9 million uninsured children in 2007, 60% lived in a household with a parent who
worked full-time for the entire year.
Health Insurance Coverage by Population Characteristics
Demographic and Family Characteristics. As shown in Table 1, children1
aged 13 to 18 had higher rates of employment-based coverage than younger children, but
were more likely to be uninsured because they were less likely to have public coverage.
Uninsured rates were highest among Hispanic children, who had the lowest employment-
based coverage rates of any race/ethnic group. Children who were black or Hispanic were
more than twice as likely to have public coverage as white or Asian children. Children
in the South and West were more likely to be uninsured than children in the Northeast and
Midwest.
1 Census Bureau estimates for children generally refer to individuals under age 18. Most
estimates in this report refer to individuals under age 19, which corresponds with the cutoff used
for Medicaid poverty-related child eligibility and the State Children’s Health Insurance Program
(SCHIP) allotment formula.

CRS-2
Table 1. Health Insurance Coverage and Demographic and Family
Characteristics of Children Under Age 19, 2007
Type of insurancea
Uninsured
Population
Employment-
Private
Military or
(thousands)
basedb
nongroup
Publicc
veterans’
Percent
Thousands
All children under age 19
78,651
60.7%
5.3%
27.9% +
2.8%
11.3% –
8,872 –
Age
Under 6
24,944
56.1%
4.6%
34.0% +
2.8%
10.5% –
2,618
6 to 12
27,855
61.7%
5.6%
27.7%
2.7%
10.4%
2,903
13 to 18
25,852
64.0%
5.6%
22.4% +
3.0%
13.0% –
3,351 –
Race/ethnicity
White
44,736
72.4%
6.4%
18.8%
3.2%
7.5%
3,353
Black
11,574
46.8%
3.3%
43.7% +
3.2%
12.8% –
1,476 –
Hispanic
16,464
38.4%
3.1% +
42.2% +
1.5%
20.7% –
3,407 –
Asian
3,094
65.7%
8.1%
19.2%
1.8%
11.9%
367
Other
2,784
56.5%
4.9%
34.2%
5.5%
9.7% –
269 –
Region
Northeast
13,251
66.6%
4.1%
26.7%
0.9%
8.5%
1,127
Midwest
17,168
67.5%
4.9%
27.0% +
2.0% +
7.2%
1,242
South
29,265
55.4%
5.0%
29.1% +
4.2%
14.8%
4,326
West
18,968
58.5% +
7.0%
27.9%
2.9%
11.5% –
2,177 –
Children not living with parent
3,473
27.4%
2.4%
44.3% +
1.1%
30.1%
1,047
Children living with parentd
75,178
62.2%
5.4%
27.2% +
2.9%
10.4% –
7,826 –
Family type
Two parents
52,482
70.9%
6.2%
18.5%
3.4%
8.9%
4,692 –
Single dad
4,489
51.7%
4.6%
32.5%
2.4%
17.0% –
764
Single mom
18,207
39.7%
3.4%
50.9% +
1.6%
13.0% –
2,370 –
Family income-to-poverty ratio
Under 100%
12,871
15.3% –
2.7%
69.2% +
1.4%
17.3%
2,223
100% to 149%
8,320
33.7%
3.9%
52.5%
2.0%
17.5%
1,459
150% to 199%
7,339
53.5%
4.3%
33.2%
3.5%
15.2%
1,119
200% to 299%
13,591
69.8%
5.4%
19.4%
3.9%
11.1%
1,506
300%+
33,057
86.5%
7.1%
6.3%
3.2%
4.6% –
1,518 –
Parents’ health insurance coverage
Employment-based
49,817
91.4%
3.3% +
11.4%
2.5%
2.2% –
1,077 –
Private nongroup
2,961
6.7%
81.2%
15.4%
1.6%
3.0%
89
Public
8,354
3.2% –
0.1%
96.4%
1.1%
2.9%
246
Military or veterans’
788
5.7%
0.2%
6.5%
98.7%
0.3%
3
Uninsured
13,258
5.7% –
0.1% –
46.8% +
0.4%
48.4%
6,412
Source: Congressional Research Service analysis of data from the March 2008 Current Population Survey.
Note: The symbol “+” denotes a statistically significant increase over last year, with “-” denoting a
statistically significant decrease.
a. People may have more than one source of coverage; percentages may total to more than 100.
b. Includes group health insurance through current or former employer or union and all coverage from
outside the home (Census Bureau figures are slightly lower because of the exclusion of certain people
with outside coverage). Excludes military and veterans’ coverage.
c. Includes Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other state
programs for low-income individuals. Excludes military and veterans’ coverage.
d. Includes stepparent.

CRS-3
Insurance coverage among children under age 19 also differs by family structure.
As shown in Table 1, 30% of children not living with a parent lacked health insurance,
compared with 10% of children living with at least one parent. Among children living
with a parent, family structure still had an impact on health insurance coverage. Nine
percent of children living in a two-parent family were uninsured in 2007. Although
children living with a single father were more likely to have employment-based health
insurance than those living with a single mother, children living with a single father were
more likely to be uninsured because they were less likely to have public coverage.
Among children in poverty,2 15% had employment-based coverage, 69% had
Medicaid or other public coverage, and 17% were uninsured. As the family income-to-
poverty ratio increases, the likelihood of children having employment-based coverage
increases and the likelihood of having public coverage or being uninsured tends to
decrease. Among children in families with family incomes at least three times the poverty
threshold, 87% had job-based coverage and 5% were uninsured.
A child’s source of health insurance is strongly associated with parents’ coverage.
Approximately 91% of children who lived with a parent who had employment-based
coverage in 2007 also had employment-based coverage.3 Likewise, 96% of children who
lived with a parent who had Medicaid or other public coverage also had public coverage.
However, among children who lived with an uninsured parent, 48% were uninsured —
but 47% had Medicaid or other public coverage, a significant increase over 2006.
Parents’ Employment Characteristics. As shown in Table 2, among children
under age 19 who lived with a parent who worked full-time for the entire year, 72.1% had
job-based coverage, which was not significantly different from 2006. However, there was
a significant increase in public coverage, to 18.3%. As a result, the uninsurance rate
among children with a parent who worked full-time for the entire year fell significantly,
from 10.0% in 2006 to 9.1% in 2007. Among children who lived with at least one parent
who worked, but only part-time or part-year, 34.2% had job-based coverage, a significant
decline compared to 2006. Apparent increases in private nongroup and public coverage
(though not statistically significant) left the uninsurance rate for these children unchanged
between 2006 and 2007, at 14.3%. In cases where no parent worked, 71.0% of children
had public coverage and 16.6% were uninsured.
Employment-based health insurance coverage is less common for workers in small
firms than in larger ones. Job-based coverage rates were lowest and uninsured rates were
highest in 2007 among children living with a parent where the primary worker was
employed by a firm with less than 10 employees. Health insurance coverage rates also
varied substantially by industry. Less than half of children living with a parent where the
2 Among children living with at least one parent. In 2007, the poverty threshold (which is used
mainly for statistical purposes and differs slightly from the poverty guideline used for program
eligibility and other administrative purposes) for a family with two adults and two children was
$21,027.
3 When a parent had more than one source of coverage, the following hierarchy was used to
determine “primary” coverage: employment-based, private nongroup, Medicaid/Medicare,
CHAMPUS or VA, and other public. Then the parent with the “highest” coverage was used to
classify both parents’ insurance coverage. Thus, if one parent had employment-based coverage
and the other had private insurance, the parents’ coverage was classified as employment-based.

CRS-4
primary worker was in one of four industries (agriculture, construction, other services, and
leisure and hospitality) had employment-based coverage. However, more than three-
quarters of children living with a parent where the primary worker was in one of five (six,
including the armed forces) industries (financial activities, information, manufacturing,
mining, public administration) had such coverage.
Table 2. Health Insurance Coverage and Parents’ Employment
Characteristics of Children Under Age 19 Living with at Least One
Parent, 2007
Type of insurancea
Uninsured
Population
Employment-
Private
Military or
(thousands)
basedb
nongroup
Publicc
veterans’
Percent
Thousands
Children under age 19 living with
75,178
62.2%
5.4%
27.2% +
2.9%
10.4% –
7,826
–
parent
Custodial parents’ work status
At least one parent worked full-
58,799
72.1%
5.5%
18.3% +
3.1%
9.1% –
5,354
–
time and full-year
None full-time and full-year, at
10,771
34.2%
–
6.0%
52.9%
2.2%
14.3%
1,541
least one part-time or part-year
Did not workd
5,608
12.4%
3.3%
71.0%
2.0%
16.6%
931
Firm size
Under 10
11,505
31.5%
–
14.4%
36.6% +
1.6%
21.9%
2,524
10-24
5,568
46.7%
6.3%
32.9%
1.5%
17.9%
999
25-99
8,184
61.5%
5.3%
28.3%
1.8%
11.3% –
924
–
100-499
9,366
71.9%
3.7%
21.7%
1.7% +
8.2% –
770
–
500-999
3,828
75.2%
–
2.9%
21.3%
1.3%
6.7%
256
1,000+
27,650
79.1%
2.9%
17.2%
4.5%
5.1%
1,423
Not applicablee
9,077
44.5%
4.2%
49.3%
3.4%
10.3%
931
Industry
Agriculture, forestry
931
32.3%
12.9%
34.7% –
1.0%
23.9%
223
Armed forces
691
44.2%
2.2%
1.4%
100.0%
0.0%
0
Construction
6,240
48.2%
7.5%
31.4% +
1.9% +
18.9%
1,176
Education, health services
12,963
70.5%
5.1%
23.3%
2.0%
6.8% –
887
–
Financial activities
4,745
76.1%
9.2%
13.2% +
1.4%
6.3% –
299
–
Information
1,605
83.5%
4.7%
12.4%
1.0%
5.3%
84
Leisure and hospitality
4,187
37.6%
4.8%
45.4%
1.0%
18.3%
764
Manufacturing
9,113
76.5%
2.5%
19.2%
0.9%
7.5%
683
Mining
485
78.7%
2.5%
17.0%
2.2%
7.1%
35
Not applicablee
9,077
44.5%
4.2%
49.3%
3.4%
10.3%
931
Other services
2,471
39.8%
8.0%
38.5%
1.9%
17.3%
427
Professional services
6,641
60.3%
–
7.3%
24.5% +
2.5%
12.2%
812
Public administration
3,639
88.9%
3.4%
10.2%
4.2%
2.8%
100
Transportation, utilities
4,188
70.7%
4.5% +
18.4%
2.3%
11.8%
494
Wholesale and retail trade
8,202
60.0%
5.9% +
29.0%
1.5%
11.1% –
910
–
Source: Congressional Research Service analysis of data from the March 2008 Current Population Survey.
Note: The symbol “+” denotes a statistically significant increase over last year, with “-” denoting a
statistically significant decrease.
a. People may have more than one source of coverage; percentages may total to more than 100.
b. Includes group health insurance through current or former employer or union and all coverage from
outside the home (Census Bureau figures are slightly lower because of the exclusion of certain people
with outside coverage). Excludes military and veterans’ coverage.

CRS-5
c. Includes Medicare, Medicaid, the State Children’s Health Insurance Program (SCHIP), and other state
programs for low-income individuals. Excludes military and veterans’ coverage.
d. Child’s employment-based coverage may be through a parent’s former employer, from someone outside
the household (e.g., noncustodial parent), or in the child’s name (e.g., from his or her own job).
e. No firm-size or industry information is provided because the parent did not work or because coverage
is from outside the household or in the child’s name.
Characteristics of Uninsured Children
In the preceding discussion, the percentages of various groups of children were
compared in terms of their health insurance. For example, 7.5% of non-Hispanic white
children were uninsured in 2007, compared with 20.7% of Hispanic children. However,
because the United States has many more non-Hispanic white children (45 million) than
Hispanic children (16 million), the number of uninsured in each group is similar, as
shown in Figure 1.
Figure 1. Characteristics of Uninsured Children Under Age 19, 2007
(8.9 million)
Source: Congressional Research Service analysis of data from the March 2008 Current Population Survey.
Note: Numbers in millions. Totals may not sum to 100% due to rounding. “Full-time and full-year” means
at least one parent living with the child was a full-time, full-year worker. “Part-time or part-year” means
that at least one parent living with the child worked, but not full-time and full-year. Whites, blacks, and
Asians are those who are non-Hispanic and report only one race. Among non-Hispanics, individuals who
report any other single race (e.g., American Indian) or multiple races are categorized as “other.”

CRS-6
This apparent paradox — that the group least likely to be uninsured makes up a large
portion of the uninsured — exists when looking at other characteristics as well. Children
who lived with at least one parent who worked full-time for the entire year were least
likely to be uninsured (9%) compared with other children, but still composed 60% of all
uninsured children in 2007. Similarly, children in two-parent families were least likely
to be uninsured (9%) compared with others, yet made up more than half of the population
of uninsured children. This raises difficult issues for policy makers who might wish to
help uninsured children. For example, should proposals be targeted at those in two-
parent families because they are more numerous, or at other uninsured children because
they are more likely to be uninsured?
Health Insurance Coverage of Children Over Time
Health insurance estimates presented in this report thus far have referred to children
under age 19. The remainder of this report refers to children under age 18, for whom
historical estimates are more readily available.4
Between 1999 and 2007, the number of children under age 18 with
employment-based health insurance fell by 2.9 million, while public coverage increased
by 6.2 million. These changes, combined with overall child population growth over the
period of 2.1 million, led to a smaller but still statistically significant drop in the number
of uninsured children (884,000) between 1999 and 2007.
Looking at the percentage changes in coverage over the 1999 to 2007 period,
children under 18 experienced a 5.7 percentage point decline in employment-based
coverage, from 65.2% in 1999 to 59.5% in 2007. Private nongroup coverage also
declined significantly, from 5.7% in 1999 to 5.3% in 2007. However, public coverage
increased by 7.8 percentage points, from 23.2% in 1999 to 31.0% in 2007, leading to a
decline in the percentage of uninsured children of 1.5% percentage points, from 12.5%
in 1999 to 11.0% in 2007.5
4 Historical tables for 1999 forward are available at [http://www.census.gov/hhes/www/hlthins/
historic/index.html]. The analysis in this section is based on the table at [http://www.census.gov/
hhes/www/hlthins/historic/hihistt5.xls].
5 CPS health insurance estimates for years prior to 1999 are available but are not directly
comparable to those for later years because of a questionnaire change that increased the number
and percentage of people covered by health insurance beginning in 1999, as well as the absence
of revised data for years prior to 1996 that would correct a Census Bureau programming error
discovered in 2007. Based on unrevised estimates produced using the old questionnaire, the
number and percentage of uninsured children under age 18 showed year-to-year fluctuations but
grew significantly between 1987 and 1998. As employment-based coverage rates declined in the
late 1980s and early 1990s, public coverage rates rose. As employment-based coverage rates
rebounded in the mid-1990s, public coverage rates declined. Old historical tables are available
at [http://www.census.gov/hhes/www/hlthins/historic/index_old.html].