Indicator: Health insurance coverage

Definition

Individuals have health insurance coverage for preventative and emergency care.

Recommended Metric(s)

Percentage of individuals with health insurance

Percentage of eligible individuals (children or adults) enrolled in Medicaid or CHIP

Type(s) of Data Needed

Administrative data; survey data

Why it matters

Uninsured children have limited contact with health care services and more serious health problems, and forgo or do not receive essential health care or use more expensive medical services more often than those with insurance.1, 2 These issues influence attendance, concentration, and participation in school, as well as future educational and labor market outcomes.3, 4 Health insurance coverage is also important for adults and is tied to improved health care quality and access, as well as satisfaction with one’s health.5 Although programs like the Children’s Health Insurance Program (CHIP) and Medicaid can help families with low incomes obtain low- or no-cost health insurance coverage, not all eligible individuals enroll, due to both real and perceived procedural barriers.6, 7 In fact, more than one-quarter of uninsured people in 2020 were eligible for Medicaid or CHIP, and nearly two-thirds of these eligible uninsured individuals were people of color.5

Although insurance coverage has increased over time, and disparities in coverage fell after the Affordable Care Act went into effect, the likelihood of insurance coverage among Indigenous and Latino children and adults remains significantly lower than other groups.8 In 2019, 22 percent of American Indian and Alaska Native adults and 20 percent of Latino adults were uninsured, compared to 11 percent of Black adults, 8 percent of White adults, and 7 percent of Asian adults.9 Coverage rates are higher among children than adults, but disparities are similar. In 2018, American Indian and Alaska Native children were three times more likely to be uninsured than Asian, Black, and White children (13 versus 4 percent), and Latino children were twice as likely to be uninsured than their Asian, Black, and White peers (8 versus 4 percent).10

What to know about measurement

The first recommended metric captures participation in any insurance program, including those offered by the government (such as CHIP and Medicaid), employers, or community clinics, as well as those that individuals purchase (for example, through Health Insurance Marketplaces). Multiple surveys measure health insurance coverage and can be adapted for use by educational institutions or employers. At the national level, they include the Current Population Survey,11 Medical Expenditure Panel Survey,12 National Health Interview Survey,13 and Survey of Income and Program Participation.14 We also recommend that E-W systems capture participation in CHIP and Medicaid among eligible individuals, either as part of a survey (as above) or by linking administrative records from state systems. This information can be used to support families with low incomes in enrolling in these programs.

Source frameworks

This indicator appeared in five source frameworks reviewed for this report, several of which recommended measuring whether individuals are insured (or uninsured). Our proposed approach to measuring the percentage of eligible individuals enrolled in Medicaid or CHIP aligns with the National Education Association’s Great Public Schools indicator framework, which recommends measuring the percentage of eligible children enrolled in CHIP or Medicaid.

References