Children’s Health Insurance Coverage and Family Structure, 1977-1996

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Abstract
Using data from a series of nationally representative medical expenditure surveys, the authors document changes in children’s health insurance coverage in a period of two decades. Overall, it is found that the proportion of children with private coverage declined, while the proportions publicly insured and uninsured increased. However, when the authors account for differences in family structure, they find striking disparities in children’s insurance experiences. Contrary to overall trends, children in single-parent households made significant gains in private health insurance coverage after 1977 and experienced reductions in public insurance. Coincident with Medicaid expansions in the late 1980s, children in two-parent households experienced significant increases in public health insurance. It is found that the rise in the proportion of children who were uninsured in this period was largely a single-parent family phenomenon, and that parents’ marital status, employment status, and family income are crucial factors associated with children’s insurance status.