Parents' Report of Their Children's Underinsurance Status After the Affordable Care Act

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Objective: To determine the prevalence and correlates of children's underinsurance pre- and post-implementation of the Affordable Care Act (ACA). Study Design: A cross-sectional survey of a convenience sample of 5043 parents of children greater than 6 months old who had health insurance in the previous 12 months. Respondents completed the Medical Expenses for Children Survey. Pre-ACA data were collected in summer/fall of 2009 to 2011 (n = 3966); post-ACA data were collected in summer/fall 2016 (n = 1077). All data were collected within the Southwestern Ohio Ambulatory Research Network (SOAR-Net). Results: Some study parents (16.3%) were unable to follow at least 1 recommendation of their child's pediatrician due to their inability to pay for it, and 17.3% reported it had become more difficult to obtain “needed health care” in the past 3 years. Factors associated with underinsurance after adjusting for demographic factors did NOT include pre/post-ACA, but did include annual household income < $50,000 (adjusted odds ratio [AOR] = 2.71; 95% CI, 2.15-3.40). Poor child health was also a significant risk factor for underinsurance(AOR = 3.71; 95% CI, 2.61-5.29). Conclusions: About 1 in 6 study children were underinsured. The ACA did not affect the underinsurance rate. Parents continued to report that it had become more difficult to obtain needed health care over the past 3 years post-ACA. About one third of study parents consistently reported that the health of their underinsured child had suffered because they could not afford to pay for their child's health care.