The findings are included in the report "Health Insurance Coverage of Children in Iowa," a collaborative effort by the University of Iowa Public Policy Center, the Iowa Department of Public Health and the Child Health Specialty Clinics based at the UI. The report was based on the Iowa Child and Family Household Health Survey of summer 2000.
The analysis is the first comprehensive attempt statewide to evaluate the status of health insurance for children, and the report points to several trends that policymakers should consider, said Peter Damiano, D.D.S., one of the report's authors and director of the Health Policy Research Program at the UI Public Policy Center.
"One of the most important things we saw was that nearly one in eight children, or 12 percent, were without health insurance at some point in 2000. Although the data are from 2000, national studies indicate that the number of insured children has not changed since then," said Damiano, who also is a professor in the UI College of Dentistry.
The survey used telephone interviews of randomly selected families in the state. Of 4,590 families contacted, 71 percent, or 3,241, agreed to participate in an interview. Each interview included nearly 125 questions and was conduced by the Center for Social and Behavioral Research at the University of Northern Iowa.
The study found that at the time of the interviews, 6 percent of the families had no insurance for their children. Another 6 percent of the families reported their children were uninsured at some point in the prior 12 months. Combined, these figures indicate 12 percent of Iowa children (approximately 90,000) are uninsured annually.
The study also revealed that 80 percent of these uninsured Iowa children were eligible for either Medicaid or hawk-i, which is a state/federal program that provides insurance to children in low-income families. Almost six out of 10 uninsured children live in families earning less than 133 percent of the federal poverty level and could be eligible for Medicaid. For a family of four that annual income would be about $18,400 per year.
"One of the big policy implications is that we are not doing a very effective job enrolling children who are eligible for these health insurance programs," Damiano said. "Overall, we are doing better in Iowa than in other states, but we still are talking about a significant number of children who could be helped."
A U.S. Census Bureau Population Survey (1999-20001) showed that Iowa's rate of uninsured children is about half the national average and the fifth lowest among all states. However, with more education and outreach, it might be possible to cover about four out of every five currently uninsured children in the state.
In terms of unmet needs, the study pointed to a particular problem with dental care -- one in four children in Iowa has no dental insurance.
"Even one in five children who had Medicaid, which covers dental services, were stopped from getting dental care because of the lack of providers willing to take them," Damiano said. "It is important to improve this access."
Damiano said the study also showed other ways in which having insurance does not guarantee access to care. Parents who are not insured themselves or who do not routinely seek care for themselves may be less likely to seek or use insurance coverage for their children.
"Financial ability to pay for services is only one part of access to care. It's important to recognize that people perceive in different ways whether they or their children need care," Damiano said.
"It may be appropriate to cover families as a unit rather than simply covering children. This could lead parents to use services appropriately, receive regular preventive care and establish a medical home for themselves and their children. Thus, finding ways to cover parents, who are generally young adults with relatively low health care costs, is an important consideration from a policy-making point of view," he added.
Nationally and in this Iowa study, rates of insured adults are about twice the rates of insured children. The Iowa study revealed that after parents enrolled their children into the hawk-i insurance program, there was a slight increase in the number of parents who had health insurance.
Damiano said it is not clear why the positive effect is happening. He also said it is important to note that nearly 80 percent of the uninsured are working adults and their families.
"Another major issue with uninsured children is that it puts stress on the family," Damiano said. "Nearly half of the parents who had uninsured children said they were worried about their children's well-being."
In contrast, such worry was expressed by only 16 percent of parents with children covered by Medicaid and by 5 percent of parents with children covered by private insurance.
The racial distribution of the families was 90 percent white. However, Latino children were twice as likely as non-Latino children to be uninsured. The number of children in the other racial/ethnic groups was too small to adequately measure differences in this study, Damiano said.
The study was funded by a grant from the Maternal and Child Health Bureau of the federal Health Resources and Services Administration. The report is available online at http://ppc.uiowa.edu/health/iowachild2000/index.html.
A previous report by the UI Public Policy Center and the Iowa Department of Human Services showed that the hawk-i program increases access to health care for Iowa's children. For more details, see this UI news release at http://www.uiowa.edu/~ournews/2001/march/0329hawki-insurance.html.
The UI Public Policy Center Web site is http://ppc.uiowa.edu.
National reports on health coverage and the uninsured are available at the Henry J. Kaiser Family Foundation Web site, http://www.kff.org/uninsured/index.cfm.
People interested in learning more about child health insurance programs in Iowa can ask their doctor, school nurse or county human services office. In addition, information on hawk-i and Medicaid insurance programs for children is available online at http://www.hawk-i.org or by calling 800-257-8563.
STORY SOURCE: University of Iowa Health Science Relations, 5137 Westlawn, and Iowa City, Iowa 52242-1178.
CONTACTS: hawk-i insurance program: 800-257-8563, http://www.hawk-i.org.
NOTE TO EDITORS: hawk-i is written in lowercase letters.