Medical Expenditure Panel Survey 

Agency for Healthcare 

Research and Quality 

STATISTICAL BRIEF #99 

September 2005 

Trends in Children’s Health Insurance 

Coverage for Families with Children, 

1996–2002 (First Half) 

Julie Hudson 

Introduction 

Health insurance for children in the United States is typically 

determined at the family level. Children covered by private insurance 

are covered by their parents through family plans that cover all 

children in the family or by adult-plus-one plans that cover one adult 

and one child. Eligibility for public insurance relies heavily on familylevel income and family size. Nevertheless, statistics for children’s 

health insurance status are often reported at the person (child) level. 

Family-level statistics provide a different aspect on children’s 

insurance status. They have the potential to differ from child-level 

statistics because families often have multiple children in the same 

household, with each child having his or her own insurance status. 

When families have multiple children with different types of insurance coverage or have varying concentrations of children with the 

same type of coverage, they provide additional information for 

researchers that is not available at the child level. 

This Statistical Brief presents data from the Household Component 

of the Medical Expenditure Panel Survey (MEPS-HC) for the first 

part of calendar years 1996 through 2002 on children’s health 

insurance coverage for families with children. All estimates in the 

brief are presented at the family level and include only those families 

with children ages 18 and under.1 For ease of presentation, the word 

“family” will be used to represent families with children age 18 and 

under. For this analysis, families are constructed to include adults 

and children who would typically be eligible for coverage under the 

adults’ private health insurance family plans (for example, children 

and their parents). 

Children’s health insurance status at the family level is reported 

using a variety of statistics. The prevalence of insurance (and 

uninsurance) is reported for families where at least one child is 

insured (or uninsured). A more detailed coverage measure reports 

1 Statistical Brief #85, Health Insurance Status of Children in America, 1996–2004: 

Estimates for the U.S. Civilian Noninstitutionalized Population under Age 18, presents 

MEPS estimates for children’s health insurance at the person level. 

Highlights 

¢ In the first part of 2002, 

86.6 percent of families had 

at least one child who was 

insured and 16.2 percent of 

families had at least one 

child who was uninsured— 

a three percentage point 

increase and decrease, 

respectively, since the first 

part of 1996. 

¢ Increases in the percentage 

of families with an insured 

child were primarily due to 

increases in insurance for 

families with incomes below 

200 percent of the Federal 

poverty level. 

¢ Decreases in the percentage 

of families with an uninsured 

child are more dramatic in 

families with incomes below 

200 percent of the Federal 

poverty level. 

¢ In the first part of 2002, 59.6 

percent of families had all 

their children covered by 

private insurance, 21.2 percent had all their children 

covered by public insurance, 

and 13.4 percent had all 

uninsured children and 5.8 

percent had children in the 

same family with different 

types of insurance coverage. 

¢ Families where all children 

were covered by public 

insurance increased by five 

percentage points and those 

with all uninsured children 

dropped by three percentage points between the first 

parts of 1996 and 2002. 
children’s insurance status across four categories: 1) families where all children are covered by private 

insurance, 2) families where all children are covered by public insurance, 3) families where all children 

are uninsured, and 4) families where children in the same family have different types of insurance 

coverage (for example, one child may be uninsured, while another is covered by public insurance). 

All differences between estimates discussed in the text are statistically significant at the 0.05 level 

unless otherwise noted. 

Findings 

In the first part of 2002, 86.6 percent (figure 1) of U.S. families had at least one child covered by health 

insurance (36.6 million families, not shown). This represents a significant increase of almost 3 

percentage points since the first part of 1996, when 83.7 percent of families had an insured child (33.3 

million, not shown). Much of the increase in insurance was driven by families with incomes below 200 

percent of the Federal poverty level (FPL). The percentage of families with an insured child increased 

seven percentage points between the first parts of 1996 and 2002 among families with incomes below 

200 percent of FPL (75.4 percent to 81.6 percent) but remained stable for families with incomes above 

200 percent of FPL (at about 88.9 percent) (figure 2). 

During the same time period, the number and percentage of families with at least one uninsured child 

dropped significantly (figure 1): 19.3 percent of families had an uninsured child in the first part of 1996 

(7.7 million, not shown) versus only 16.2 percent of families in the first part of 2002 (6.8 million, not 

shown). Mirroring trends for insurance, this decrease was primarily driven by families with incomes 

below 200 percent of FPL. In the first part of 1996, 29.4 percent of families with incomes below 200 

percent of FPL had an uninsured child versus only 23.4 percent in the first part of 2002 (figure 3). For 

families above 200 percent of FPL, the percentage of families with an uninsured child was stable at 

about 12.6 percent. 

In the first part of 2002, 86.6 percent of families had children who were covered by either private or 

public insurance; 25.1 million (not shown) or 59.6 percent of families had all children covered by private 

insurance (figure 4). Alternatively, 9.0 million (not shown), or 21.2 percent had all children covered by 

public insurance. Only 13.4 percent of families, or 5.6 million (not shown), had all children uninsured for 

the entire first part of 2002. A small percentage of families (5.8 percent) had children with differing types 

of insurance coverage. All 2.5 million (not shown) of these families had at least one insured child (either 

public or private or both), but almost half of these families, 1.1 million, also had at least one uninsured 

child. 

In comparison to children’s insurance status for families in the first part of 1996, increases in insurance 

rates for families with children in the first part of 2002 were driven by increases in families with public 

coverage (figure 5). Despite the stability in estimates of private coverage between the first parts of 1996 

and 2002 (62.4 percent to 59.6 percent), the percentage of families with all uninsured children fell by 

three percentage points (16.3 percent to 13.4 percent). Increases in public coverage compensated for 

the drop in private coverage, with a five percentage point increase from 16.1 percent to 21.2 percent. 

These changes coincided with expansions in public insurance through the State Children’s Health 

Insurance Program and Medicaid and increased take-up of public insurance for Medicaid-eligible 

children.2 

Data Source 

The estimates provided in this Statistical Brief come from the 1996 through 2002 MEPS-HC files (HC01, HC-05, HC-09, HC-13, HC-22, HC-34, and HC-53) with point-in-time estimates for the early part of 

calendar years 1996 through 2002 for Round 1 persons in Panels 1 through 7 and Round 3 persons in 

Panels 1, 2 and 4 through 6. The point-in-time MEPS-HC files contain data on family structure, 

employment, health insurance, health status, and demographic characteristics of both individuals and 

households for the first part of the calendar year. 

2 Selden, T. M., Hudson, J. L. and Banthin, J. S. Tracking Changes in Eligibility and Coverage among Children, 1996–2002. 

Health Affairs 23, no. 5 (2004): 39–50. 
Definitions 

Family 

Families are constructed to include adults and those family members who would typically be eligible for 

coverage under the adults’ private health insurance family plans, a grouping otherwise known as health 

insurance eligibility units (HIEUs). These families comprise adults, their spouses, and their unmarried 

natural/adoptive children age 18 and under. Unmarried minors living without their natural/adoptive 

parents are included in the family of their stepparent, grandparent or aunt/uncle. Married minor children 

are placed in a separate family with their spouses and their own children. Children of unmarried minors 

are placed, along with their minor parent, in the family of their adult grandparents. Foster children and 

unmarried minors living without any adult family member constitute their own independent families 

without adults. 

Age 

Children are ages 18 and under. Note that some other MEPS Statistical Briefs use different age ranges 

for children and adults and will report slightly different estimates for insurance status. 

Insurance status for children 

Insurance status for children is measured over the current round of the survey. In these files, the round 

took place in the first part of calendar years 1996 through 2002. Individual insurance coverage is 

defined by the following mutually exclusive categories: 1) both public and private insurance during the 

round, 2) any private insurance during the round, 3) any public insurance during the round, and 4) 

uninsured for entire round. These categories do not overlap, so a child with both public and private 

insurance during the round would appear in category 1 but would not appear in categories 2 or 3. 

Insurance status for families 

Insurance status for families is based on the insurance status of the children within each family and, 

therefore, also reflects coverage over the current round of the survey. This represents coverage in 

families for the first part of calendar years 1996 through 2002. Family-level insurance coverage is 

defined by the following mutually exclusive categories describing insurance coverage for children within 

the family: 1) all children covered by private insurance at some point in the round, 2) all children 

covered by public insurance at some point in the round, 3) all children uninsured for the entire round, 

and 4) children in the same family with differing insurance coverage. Category 4 includes two types of 

families: those with a child who was covered by both public and private insurance during the round and, 

more commonly, those who had two or more children with different types of coverage in the round. For 

example, a family might have one child who was covered by public insurance at some point during the 

round and another child who was uninsured for the entire round. 

Statistics on families with at least one insured (or uninsured child) are not mutually exclusive. They 

measure A) whether there was at least one child in the family who had insurance at any point in the 

round and B) whether there was at least one child in the family who was uninsured for the entire round. 

If a family has a one child who was covered by public insurance and another child who was uninsured, 

they would be represented in categories A and B. 

Federal poverty level 

Family income and size are used to calculate the Federal poverty level. Individual incomes are 

measured by taking annual earned income and unearned income for each family member and are 

summed across all family members to get family income. Family income and size are used to obtain the 

Federal poverty level for each family. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of 

social, demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 
For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care 

Policy and Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. 

MEPS Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care 

Policy and Research, 1997. 

Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care, 

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Hudson, J. L. Trends in Children’s Health Insurance Coverage for Families with Children, 1996–2002. 

Statistical Brief #99. September 2005. Agency for Healthcare Research and Quality, Rockville, Md. 

http://www.meps.ahrq.gov/papers/st99/stat99.pdf 

� � �

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD 

Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

83.7 84.9 84.8 85.8 83.8 84.7 86.6

19.3 18.9 17.9 17.7 16.8 17.8 16.2

0

10

20

30

40

50

60

70

80

90

1996 1997 1998 1999 2000 2001 2002

Any child insured in family Any child uninsured in family

Percentage of families 

with children

Figure 1. Trends in children’s insurance coverage

for families with children, 1996–2002

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

89.0 88.4 89.0 89.9 89.0 89.4

81.6

76.3 76.6 77.5

79.2

77.9

75.4

86.6

84.9 84.8 84.7 83.6 83.8

85.8

87.7

70

80

90

1996 1997 1998 1999 2000 2001 2002

Families below 200% FPL All families Families above 200% FPL

Figure 2. Families with an insured child, 

by Federal poverty level, 1996–2002

Percentage of families 

with an insured child
i i l i l i l 

i i i il

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 

1996–2002 Po nt­ n-T me F es. 

12.7 12.9 12.2 

13.7 

11.5 12.6 12.3 

23.4 

28.7 27.9 27.6 

24.8 

26.7 

29.4 

16.2 

19.3 18.9 17.9 17.7 17.8 

16.8 

10 

20 

30 

1996 1997 1998 1999 2000 2001 2002 

Families below 200% FPL All families Families above 200% FPL 

Figure 3. Families with an uninsured child, 

by Federal poverty level, 1996–2002 

Percentage of families 

with an uninsured child 

i i l i l i l 

i i i il

Source: Center for F nanc ng, Access, and Cost Trends, AHRQ, Househo d Component of the Med ca Expend ture Pane Survey, 

1996–2002 Po nt­ n-T me F es. 

21.2% 13.4% 

5.8% 

59.6% 

Only private Only public 

Only uninsured Mixed coverage 

Figure 4. Children’s insurance coverage 

for families with children, 2002 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey,

1996–2002 Point-in-Time Files.

62.4

16.1 16.3

5.2 5.8

13.4

21.2

59.6

0

10

20

30

40

50

60

Only private Only public Only uninsured Mixed coverage

1996 2002

Percent

Figure 5. Children’s insurance coverage

for families with children, 1996 versus 2002