Almost One-Quarter of U.S. Children Underinsured

U.S. Department of Health & Human Services
Health Resources and Services Administration
Wednesday, August 25, 2010

Underinsurance of Children More Common than Lack of Insurance, Study Finds

More than 14 million U.S. children (22.7%) were underinsured in 2007, according to the study, Underinsurance among Children in the United States, conducted by researchers at the Health Resources and Services Administration (HRSA) and published today in the New England Journal of Medicine.

This is more than the number of children without insurance at all during the year (3.4 million) and the number of children who had insurance during only part of the year (7.6 million). 

The study drew data from the 2007 National Survey of Children’s Health,a nationally-representative study which looked at more than 91,000 children and examined underinsurance, or insurance that does not sufficiently meet a child’s needs.  Researchers looked at children who were never insured in the previous year, children who were insured only part of the year and children who had health insurance throughout the year.  

“Much has been written about expanding health insurance coverage for children,” said lead author Dr. Michael D. Kogan, a researcher in HRSA’s Maternal and Child Health Bureau.  “Far less attention has been devoted to whether insurance sufficiently meets children’s needs.” 

Kogan co-authored the study with Reem M. Ghandour, Dr.P.H., Gopal K. Singh, Ph.D., Bonnie B. Strickland, Ph.D., Peter C. van Dyck, M.D., M.P.H., Paul W. Newacheck, Dr.P.H. (University of Calif.) and Stephen J. Blumberg, Ph.D. (Centers for Disease Control and Prevention).

The study asked parents three key questions: whether parents thought that their child’s health insurance offered benefits or covered services that met his or her needs; whether the child’s health insurance allowed them to see needed providers; and whether out-of-pocket costs were reasonable (not including health insurance premiums or costs covered by insurance).  The child was considered underinsured if the parent did not answer “usually” or “always” to all three of these questions, even if they were insured throughout the year.

Other findings include:

  • Older children, black and Hispanic children, children in fair or poor health and children with special health care needs were more likely to be underinsured. 
  • Children with private insurance were more likely to be underinsured than those with public insurance (24.2 percent versus 14.7 percent).
  • The most common reason for underinsurance was that costs paid by the family were not reasonable.
  • Publicly insured children were more likely to report difficulties seeing needed providers, whereas parents of privately insured children were much more likely to report having inadequate coverage of charges.
  • Underinsured children have problems with access to health care similar to those of uninsured children.

Compared to children who were consistently and adequately insured throughout the year, underinsured children were more likely to have difficulty obtaining referrals for needed care, lacked a usual source of care, delayed or did not get needed care and had problems getting care from specialists when needed.


The Health Resources and Services Administration (HRSA), part of the U. S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated, or medically vulnerable. For more information about HRSA and its programs, visit

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Date Last Reviewed:  March 2017