Uninsured Children: Do Child Support Policies Matter?

The absence of universal health care in the U.S. is noteworthy among developed countries. In 2004, 11.2 percent of American children under the age of 18 had no health insurance (Census Bureau, 2005) and, as a result, faced serious health consequences. Without health insurance, children face postponed care and lack of preventative care; are less likely to be up to date on needed vaccinations; face inadequate care of chronic conditions; are three times more likely to have unmet medical needs compared to insured children; use more expensive and unnecessary services such as urgent care and emergency departments; and are more likely to fall behind in school. Though many researchers have investigated the effectiveness of the Medicaid and SCHIPS programs at increasing health insurance for children, the link between other policies and health-care coverage has been largely unexplored. In this paper we focus on the effect that child-support policies have on health insurance for children. The adoption of policies aimed at increasing child-support awards and collection has bolstered the living standards of many children with absent fathers and reduced the welfare caseload. In addition to the direct increase in income, child-support awards and payments may alter health insurance for children either because the legal divorce agreement may include the provision of health insurance, or because the increase in income allows residential parents to afford health insurance premiums. We exploit differences in child-support policies across states and over time to determine whether improvements in child-support establishment and enforcement efforts have any impact on insurance coverage for children. Using data from the National Longitudinal Survey of Youth 1979 cohort (NLSY79) and the NLSY79 Children and Young Adults Survey we estimate a multinomial logit model of having no insurance, public insurance or private insurance and find that child-support policies have some potential for easing the incidence of non-insurance for children with a nonresident father. Our results suggest that more vigorous child-support efforts by the state have the potential to increase insurance probabilities among children whose parents divorced or separated. Increases in the vigor and efficiency of child-support collection efforts can move children who previously had no insurance to privately-provided insurance. Such a move can have important implications for children's health. For children born outside of marriage child-support efforts do little to increase insurance, but may ease the public burden by moving children from public insurance to privately-provided insurance. The impact of this shift in coverage on children's health is not clear. There is some evidence that publicly-provided insurance increases the probability that children receive regular preventive care although children with private insurance were found to have more frequent visits to a doctor for the treatment of an illness. In contrast, other researchers found that patients enrolled in Medicaid were twice as likely to report lack of access to necessary care than patients covered by private health insurance. Another study found that among children with chronic conditions, Medicaid enrollment was associated with more lab tests and office visits than similar children with private coverage.