78 - Childhood Underinsurance During the COVID-19 Pandemic

Access to health insurance plays a vital role in children's health. The significant disparity in children's health insurance affects their access to quality health care. Earlier work has found no effect of the Affordable Care Act on children's underinsurance status in southwestern Ohio. This study examines childhood underinsurance in southwestern Ohio during the COVID-19 pandemic.

Objective:

To document the prevalence and correlates of children's underinsurance during the COVID-19 pandemic.

Design/Methods:

This is a cross-sectional study of a convenience sample of children seen in primary care pediatric practices within the Southwestern Ohio Ambulatory Research Network (SOAR-Net). Recruitment of study primary caregivers (PCGs) occurred in waiting rooms of participating SOAR-Net practices from June 2021-November 2022. Respondents completed the Medical Expenses of Children Survey (MEoCS), which has been used in similar research since 2009. Index children were considered underinsured if their PCG responded "yes" to at least one of six questions regarding inability to pay for a pediatrician's recommendation despite the child having health insurance. PCGs with a child between the ages of 6 months and 18 years were eligible.

Results:

810 PCGs completed the MEoCS with a response rate of about 80%. 78% of respondents were the index child's mother, 75% were white, and 64% were married. About 36% had a college degree, and 49% of PCGs reported annual income of at least $50,000. 12% of index children were underinsured with the highest rate (18%) among children aged 5 - 11.9 years. Almost 37% of PCGs raising underinsured children reported that it was harder to access care for their child compared to 3 years ago, while only 8% of PCGs raising not underinsured children reported it was harder (P< 0.001). PCGs of underinsured children were more likely to report that COVID-19 had a negative effect on their child’s mental health (50%) compared to not underinsured children (28%, P< 0.001); not underinsured children were also more likely to receive the COVID-19 vaccine or be vaccinated (52%) compared to underinsured children (38%, P=0.011).

Conclusion(s):

About 1 in 8 children are underinsured in southwestern Ohio compared to about 1 in 7 from a 2016 study that also used the MEoCS. Underinsurance status varies by age and the highest rate (18%) is among children aged 5 - 11.9 years. Half of PCGs of underinsured children report the pandemic had a negative effect on their child's mental health. Future longitudinal research should examine children's underinsurance and its association with children's health.