Lack of Health Insurance Places Entire Families at Risk

Armen Hareyan's picture

Family Health Insurance

If just one member of a family does not have health insurance, it adversely affects the health, emotional well-being, and financial stability of the entire household, says a new report from the National Academies' Institute of Medicine. Roughly 58 million people in the United States are either uninsured or live with a family member who is uninsured. One in five families have at least one member who is not covered.

"People without insurance generally have less positive experiences with the health system and are less likely to get regular care for themselves or their dependents, even if these dependents are insured," said Arthur Kellermann, professor and chair of emergency medicine at Emory University School of Medicine, Atlanta, and co-chair of the committee that wrote the report. "The stress of having even one uninsured family member can ripple through the household as other family members cope with their relative's illness, high medical bills, and financial distress. Moreover, even if every member of a family has insurance today, changes in the plan-holder's eligibility or employment status can mean sudden loss of coverage for some or all in the household tomorrow."

Health insurance, the principal means by which Americans obtain health care, is frequently offered on an individual basis or with only partial regard to family circumstances. Coverage for dependents under employment-based health plans can be disrupted if plan-holders lose or change jobs, retire, divorce, or die. Public insurance programs are available to cover specific groups, such as children and low-income pregnant women who cannot get private insurance, but these programs typically do not extend coverage to all other family members. The mismatch between family needs and the conditions under which coverage is available is at the root of many of the negative consequences of being uninsured, the committee found.

Children in particular are affected by lack of insurance because they rely on their parents or guardians to obtain both coverage and health care for them. The negative experiences of uninsured parents in obtaining care for themselves may affect their willingness to take their children for checkups or enroll them in public insurance plans.

More than half of the nation's 8 million uninsured children are eligible for Medicaid or State Children's Health Insurance Program (SCHIP), but are not enrolled. When certain states expanded Medicaid coverage to include low-income parents as well as their children, enrollment of children increased more than in states without the parental coverage, the committee found. However, future expansions of Medicaid and SCHIP may be affected by the recent recession, the report cautions. There are likely to be more individuals eligible for public coverage as unemployment rises. Facing budget constraints, some states may either stop expanding public coverage or cut it back.

Studies demonstrate that uninsured parents delay seeking care for themselves and their uninsured children until the symptoms are more severe. These delays may result in unnecessary hospitalizations for preventable or readily treatable conditions. Uninsured children are less likely to have a regular source of primary care than insured children, and they use medical and dental services less often. National data show that only 51 percent of uninsured children had a physician visit during the previous year, compared with 76 percent of insured children. Only 21 percent of uninsured children had a regular dental checkup, while half of insured children did. On average, sick newborns without health coverage receive two fewer days of hospital care than those with insurance.


When parents experience poor physical or mental health, their children's emotional health and development may suffer as a result. Studies show that parental depression increases the chances that children will exhibit greater difficulty in learning to socialize, poorer academic performance and school behavior, and higher rates of mood disorders.

Lack of insurance can seriously strain families' financial stability, the committee found. Families with no members insured for a year are more than twice as likely as families with full coverage to incur medical expenses that exceed 10 percent of their income. Most uninsured families cannot afford to buy coverage independently. The median income for two-parent families in which both parents have insurance is $67,000, compared to $30,000 for families in which neither parent has coverage and $14,280 for single parents who lack insurance.

"Given the high premium costs of independently purchased insurance, coverage might require a quarter or more of the family's income," said Mary Sue Coleman, president of the University of Michigan, Ann Arbor, and co-chair of the IOM committee. "For lower-income families, there is not much left in the budget after paying for necessities such as food and rent." Nonetheless, uninsured families pay more than 40 percent of their medical expenses out of pocket on average. The remainder is absorbed by health care providers, hospitals, charities, and the larger community.

Families without full coverage also are disproportionately headed by single parents and are more likely to be immigrants or racial and ethnic minorities. In addition to lack of financial means, they often face multiple barriers to care, including cultural differences, less education, and language barriers.

Private, employment-based health plans increase the likelihood that all family members will be covered, but these plans also have limitations. Changes in the plan-holder's eligibility or status often disrupt coverage for the entire family. Families with members in late middle age and approaching retirement are most susceptible to the negative consequences of losing coverage, since they tend to have greater health care needs and higher medical costs than younger families. Although the Consolidated Omnibus Budget Reconciliation Act, or COBRA, offers protection during transitional periods to some of those with workplace coverage, many families cannot afford to pay for it. Also, the cost of health care is once again rising fast, resulting in higher premiums, co-payments, and deductibles. This may lead more employees to decide they cannot afford coverage for themselves or their families, and more employers to reduce their coverage offerings.

This report is the third of six that will provide an extensive review of research intended to paint an accurate portrait of who lacks health insurance and why, along with the personal, social, and economic consequences. These reports are designed to lay the groundwork for a more informed and productive public debate about health care coverage. The committee's final report will identify promising strategies for addressing the problems of uninsurance in the United States.

The study is sponsored by the Robert Wood Johnson Foundation. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.

Read the full text of Health Insurance Is a Family Matter for free on the Web, as well as more than 1,800 other publications from the National Academies. Printed copies are available for purchase from the National Academy Press Web site or by calling (202) 334-3313 or 1-800-624-6242.