Infants without health insurance: Racial/ethnic and rural/urban disparities in infant households’ insurance coverage

Autoři: Scott R. Sanders aff001;  Michael R. Cope aff001;  Paige N. Park aff001;  Wesley Jeffery aff001;  Jorden E. Jackson aff001
Působiště autorů: Department of Sociology, Brigham Young University, Provo, Utah, United States of America aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222387


In order to gain insights into how the effects of the uneven adoption of Medicaid expansion varies across the rural/urban spectrum and between racial/ethnic groups in the United States, this research used the fertility question in the 2011–2015 American Community Survey to link infants’ records to their mothers’ household health insurance status. This preliminary exploration of the Medicaid expansion used logistic regression to examine the probability that an infant will be born without health insurance coverage. Overall, the states that adopted Medicaid expansion improved the health insurance coverage for households with infants. However, rural households with infants report lower percentages of coverage than urban households with infants. Furthermore, the rural/urban gap in health insurance coverage is wider in states that adopted the Medicaid expansion. Additionally, Hispanic infants remain significantly less likely to have health insurance coverage compared to Non-Hispanic White infants. Understanding infant health insurance coverage across ethnic/racial groups and the rural/urban spectrum will become increasingly important as the U.S. population transitions to a minority-majority and also becomes more urban. Although not a perfect solution, our findings showed that the Medicaid expansion of health insurance coverage had a mainly overall positive effect on the percentage of U.S. households with infants who have health insurance coverage.

Klíčová slova:

Census – Health insurance – Hispanic people – Infants – Medicine and health sciences – Native American people – Pediatrics – Urban areas


1. Assaf S, Campostrini S, Gotway Crawford C, Di Novi C, Xu F. Analyzing Disparities Trends for Health Care Insurance Coverage Among Non-Elderly Adults in the US: Evidence from the Behavioral Risk Factor Surveillance System, 1993–2009. The European Journal of Health Economics. 2014;18.3: 387–398.

2. Sommers BD, Gunja MZ, Finegold K, Musco T. Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act. Jama. 2015;314.4: 366–374. doi: 10.1001/jama.2015.8421 26219054

3. Blumenthal D, Collins SR. Health care coverage under the Affordable Care Act—a progress report. The New England Journal of Medicine. 2014:371.3: 275–281. doi: 10.1056/NEJMhpr1405667 24988300

4. Manatt P, Phillips LLP. Medicaid's Impact on Health Care Access, Outcomes and State Economies. Robert Wood Johnson Foundation. 2019.

5. Clotfelter CT, Ladd HF, Vigdor JL. New destinations, new trajectories? The educational progress of Hispanic youth in North Carolina. Child development. 2012;83.5: 1608–1622. doi: 10.1111/j.1467-8624.2012.01797.x 22966926

6. Duncan GJ, Ziol‐Guest KM, Kalil A. Early‐childhood poverty and adult attainment, behavior, and health. Child development. 2010;8.1: 306–325.

7. Borjas GJ. Poverty and program participation among immigrant children. The Future of Children. 2011;21.1: 247–266. doi: 10.1353/foc.2011.0006 21465863

8. Call KT, McAlpine DD, Garcia CM, Shippee N, Beebe T, Adeniyi TC, et al. Barriers to care in an ethnically diverse publicly insured population: is health care reform enough? Medical care. 2014;52.8: 720–727. doi: 10.1097/MLR.0000000000000172 25023917

9. Curtin SC, Osterman MJ, Uddin SF, Sutton SR, Reed PR. Source of payment for the delivery: births in a 33-state and District of Columbia reporting area. 2010. National Vital Statistics Reports: From the Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System. 2013;62.5: 1–20.

10. Ziller EC, Coburn AF, Anderson NJ, Loux SL. Uninsured rural families. The Journal of Rural Health. 2008;24.1: 1–11. doi: 10.1111/j.1748-0361.2008.00131.x 18257865

11. Ziller EC., Lenardson, JD, Coburn AF. Rural adults delay, forego, and strategize to afford their pre-ACA health care. 2015.

12. Newkirk V, Damico A. The Affordable Care Act and insurance coverage in rural areas. The Kaiser Commission on Medicaid and the Uninsured. 2014.

13. Benitez JA., Seiber EE. US Health Care Reform and Rural America: Results From the ACA's Medicaid Expansions. The Journal of Rural Health. 2018;34.2: 213–222. doi: 10.1111/jrh.12284 29105809

14. Kwon D. Should you take an app for that. Scientific American. 2015.

15. Karpman M, Zuckerman S, Kenney GM, Odu Y. QuickTake: Substantial Gains in Health Insurance Coverage Occurring for Adults in Both Rural and Urban Areas. 2015.

16. Hargraves JL, Hadley J. The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health services research. 2003;38.3: 809–829. doi: 10.1111/1475-6773.00148 12822914

17. Lillie-Blanton M, Hoffman C. The role of health insurance coverage in reducing racial/ethnic disparities in health care. Health affairs. 2005;24.2; 398–408. doi: 10.1377/hlthaff.24.2.398 15757923

18. Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. (2016). Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. American journal of public health. 2016;106.8: 1416–1421. doi: 10.2105/AJPH.2016.303155 27196653

19. Monnat SM. Hispanic Health Insurance Rates Differ between Established and New Hispanic Destinations. 2016.

20. Ruggles S, Flood S, Goeken R, Grover J, Meyer E, Pacas J, et al. IPUMS USA: Version 8.0 [dataset]. Minneapolis, MN: IPUMS, 2018.

21. Lichter DT., Sanders SR, Johnson KM. Hispanics at the starting line: poverty among newborn infants in established gateways and new destinations. Social Forces. 2015;94.1: 209–235.

22. Bliss J, Jensen N, Thiede B, Shoham J, Dolan C, Sibson V, et al. Factors associated with the risk of acute malnutrition among children aged 6 to 36 months in households targeted by an emergency cash transfer program. Food and nutrition bulletin. 2016;37.3: 387–400. doi: 10.1177/0379572116654772 27402641

23. Garrett AB, Gangopadhyaya A. Who gained health insurance coverage under the ACA, and where do they live?. Urban Institute, ACA Implementation—Monitoring and Tracking. 2016. [Map 1].

24. Young IM. Gender as seriality: Thinking about women as a social collective. Gender and Justice, Routledge. 2017; 3–28.

25. Hoffmann JP. Regression models for categorical, count, and related variables: An applied approach. Oakland: Univ of California Press; 2016.

26. Mitchell MN. Interpreting and visualizing regression models using Stata (No. 005.369 M58.). College Station, TX: Stata Press; 2012.

27. Lichter DT, Johnson KM, Turner RN, Churilla A. Hispanic Assimilation and Fertility in New US Destinations. International Migration Review. 2012;46.4: 767–791. doi: 10.1111/imre.12000 23325987

28. Soni A, Hendryx M, Simon K. Medicaid expansion under the Affordable Care Act and insurance coverage in rural and urban areas. The Journal of Rural Health. 2017;33.2: 217–226. doi: 10.1111/jrh.12234 28114726

29. Monnat SM. The new destination disadvantage: disparities in Hispanic health insurance coverage rates in metropolitan and nonmetropolitan new and established destinations. Rural sociology. 2017;82.1: 3–43. doi: 10.1111/ruso.12116 28479612

30. Bloom B, Black LI. Health of Non-Hispanic Asian Adults: United States, 2010–2014. NCHS data brief. 2016;247: 1–8.

31. Clemans-Cope L, Kenney GM., Buettgens M, Carroll C, Blavin F. The Affordable Care Act’s coverage expansions will reduce differences in uninsurance rates by race and ethnicity. Health Affairs. 2012;31.5: 920–930. doi: 10.1377/hlthaff.2011.1086 22566430

32. Currie J. The Take Up of Social Benefits. [Working Paper No. 10488] National Bureau of Economic Research, Cambridge, MA. 2004.

33. Derose KP, Escarce JJ, Lurie N. Immigrants and health care: sources of vulnerability. Health Affairs. 2007;26.5: 1258–1268. doi: 10.1377/hlthaff.26.5.1258 17848435

34. Gee ER. Eligible Uninsured Latinos: 8 in 10 Could Receive Health Insurance Marketplace Tax Credits, Medicaid, or CHIP. Washington DC: Department of Health and Human Services, Office of Assistant Secretary for Planning and Evaluation. 2014.

35. Ku L, Matani S. Left out: immigrants’ access to health care and insurance. Health Affairs. 2001;20.1: 247–256. doi: 10.1377/hlthaff.20.1.247 11194848

36. Thiede BC, Sanders SR, Lichter DT. Born Poor? Racial Diversity, Inequality, and the American Pipeline. Sociology of Race and Ethnicity. 2018;4.2: 206–228.

Článek vyšel v časopise


2020 Číslo 1