NEWS 2011

The Family Plan

Better Health When One Insurance Plan Covers All

Mixed Coverage forms

One of the main goals of the healthcare reform law was to increase the number of insured Americans, including children. But insurance coverage, whether public or private, is not enough to ensure that children will receive timely, quality care, according to new findings by IPR sociologist Christine Percheski.

Using data from the National Health Interview Survey and the Medical Expenditure Panel Survey, Percheski and her colleague Sharon Bzostek of Harvard are the first to link national data on health insurance coverage and medical care for siblings. Although siblings in most American families are covered by a single health insurance plan, complex insurance arrangements are common among the rising numbers of children growing up in stepfamilies, in which stepsiblings and half-siblings might not qualify for the same coverage.


Christine Percheski

“Today, about 6 percent of American children have a different coverage type than their siblings—most of the time with at least one child receiving public assistance,” Percheski said. Children in Hispanic, low-income, and stepfamilies are much more likely to experience mixed health insurance coverage than other children.

The difficulties that parents face in navigating multiple healthcare bureaucracies often lead to a decrease in preventive care, as well as increased emergency room visits. Because emergency care is so much more expensive than regular doctor’s visits, Percheski explained, multiple insurance plans within the same family could be contributing to a rise in overall medical costs for public and private insurance programs.

Percheski and Bzostek caution that more research is needed, especially in linking health disparities and higher medical expenditures to mixed coverage, but they suggest that reducing parents’ bureaucratic burden in these mixed-insurance families might be a worthy policy goal in and of itself.

“In changing insurance eligibility rules, we would undoubtedly increase Medicaid and SCHIP rolls, but we would reduce instances of mixed-insurance coverage, likely leading to better health outcomes for our most disadvantaged children,” Percheski said.

For example, the researchers point to expanding eligibility for Medicaid and SCHIP so that all children within a household would be eligible if one child qualifies. Another option, they suggest, would be to broaden the definition of “family” in regulations governing employer-provided insurance so that all children in the same household could be covered under a single plan.

Christine Percheski is Assistant Professor of Sociology and an IPR Faculty Fellow.