7. Health Insurance
Strong Foundations For Our Youngest Children

7. Young Children's Health Insurance Coverage

Health insurance allows individuals to receive needed health services regardless of cost. Individuals and families receive health insurance coverage through an employer, state and/or local insurance programs, or by purchasing private health insurance. The Affordable Care Act requires individuals to secure some form of health insurance coverage and creates additional options for that coverage through Health Exchanges, also known as marketplaces.

In addition to covering catastrophic and high-cost health services, insurance coverage helps people access timely medical care and preventive services and improves their lives and health. Individuals with health insurance are more likely to go to preventive health care appointments. Families with health insurance for young children are more likely to take their child to well-child visits, which are critical to prevent illness and identify and respond to potential developmental issues. Families who lack health insurance are often deterred by the cost of health care and may only seek treatment when a major medical issue arises. Preventive well-child visits are critical in supporting young children and ensuring they thrive.

Over the last 20 years, the federal government has expanded options for states to provide health coverage for children—both through Medicaid and the Child Health Insurance Program (CHIP). Through Medicaid and CHIP, most states now cover children whose families have incomes up to at least 200 percent of poverty, and many cover children in families with higher incomes. A few states cover undocumented children, although they must use state funding to do so. States are required by federal law to cover children who are legal residents after five years of being in the country, but are given the option to cover all legal resident children, and many do so.

There are different sources of information available for health insurance coverage by age, which produce somewhat different estimates of levels of child health coverage. The American Community Survey provides data that generally can be broken out for the 0-17 population and is available annually. The National Survey of Child Health provides further breakdowns by child age (0-5, 6-11, 12-17) but is available only every four years. Select information from both is provided here.

What Can the Data Tell Us?

Examining national and state data on health insurance coverage and access to care by race/ethnicity is critical to understanding disparities in health outcomes for specific groups. Levels of health insurance coverage vary significantly from state to state as well as by race, ethnicity, and socioeconomic status. Children under five years who are American Indian or Alaska Native are almost three times more likely to be uninsured than the national average, and children of Hispanic descent are much more likely to be uninsured than white, African-American or Asian children (Table 14). Differences across the states, particularly relative to poverty levels, generally reflect state policies regarding the eligibility for Medicaid and CHIP coverage.

Table 14. Health insurance coverage* by race/ethnicity, children ages 0-5, U.S., 2013


Children Age 0-5







White, Non-Hispanic




African American




American Indian and Alaska Native












Source: U.S. Census Bureau, American Community Survey,  One-Year Estimates, 2013. This data can be developed for any state; but the standard errors of estimate may be substantial for some ethnic populations.


The National Survey on Children’s Health (NSCH) provides some of this data on a state-by-state basis (Table 15). NSCH data show health insurance coverage for each state broken down by income and race/ethnicity. These data give a good picture of the state’s uninsured child population. 

Table 15. Percent of uninsured children 0-17 by race/ethnicity and poverty level, U.S. and states, 2011-2012