PhD candidate Ye Shen published a modeling study that estimated cumulative insurance experiences during childhood in JAMA, with coauthors including CHDS faculty Ankur Pandya and Nicolas Menzies.
Children’s health insurance in the United States is highly fragmented with families navigating Medicaid, the Children’s Health Insurance Program (CHIP), employment-based plans, Affordable Care Act (ACA) Marketplace plans, and other options, each with different eligibility criteria and administrative hurdles. This patchwork often leads to insurance disruptions which can reduce access to care. Studying longer-term insurance transitions in the United States is difficult because existing insurance data sources are either incomplete or limited in follow-up time. As a result, the extent of children’s cumulative insurance experiences over the first 18 years of life remains unclear.
Shen and colleagues sought to fill this gap by combining multiple national socioeconomic, demographic, and insurance data sources using a microsimulation modeling approach. The model projected individual coverage trajectories from birth to age 18 under policy conditions similar to those in 2015-2019 when major provisions of the ACA were implemented without the temporary policies introduced during the COVID-19 public health emergency.
The study’s main findings estimated that most American children enroll in Medicaid or CHIP, suggesting that the recent Medicaid policy changes and funding cuts may have widespread impact. In their model, 61% of US children enrolled in Medicaid or CHIP and 42% experienced an insurance gap at some point by their 18th birthday. Only 26% of children were continuously covered by employment-based or other non-Medicaid/CHIP/Marketplace options. They also estimated that coverage disruptions among children born in Medicaid/CHIP were most common from states with the most restrictive adult and/or child eligibility policies.
The article was one of Ye Shen’s doctoral dissertation papers. Shen is a doctoral candidate in the Harvard PhD program in Health Policy. She is currently on the job market.
Learn more: Read the full article, Insurance Dynamics During Childhood in the Fragmented US Health System
Learn more: Accompanying editorial, From Churn to Continuity—Reforming Children’s Coverage
Learn more: Harvard Chan School press release, Majority of U.S. Children Enroll in Medicaid, Many Face Coverage Gaps by Age 18
Related news: Shen Receives Dissertation Support Award