The health and economic stability of families may be affected by the variety of health insurance arrangements within families. There is much variation in uninsured rates and in patterns of insurance coverage among different types of families. Sometimes not all members of a family are covered, or if they are, each may have coverage from different sponsors and different terms of insurance. This variation is influenced by the rules, policies, and requirements of public coverage programs as well as those of employment-based insurance plans. In addition, the socioeconomic and demographic characteristics of families influence these patterns of coverage. In Coverage Matters the Committee described the characteristics of uninsured individuals. This chapter aggregates the data on individuals into family groups and describes various family configurations as a unit.
This chapter describes coverage variations, the reasons for them, and some of the implications for families. The first section gives an overview of the sources of health insurance coverage, including employment-based, individually purchased, and public coverage. Because each source or type of insurance has distinctive rules for eligibility and they do not necessarily match a family’s perception of its members, many families have some members who are uninsured. The second section examines the resulting coverage patterns of various types of families in the United States and describes how coverage varies within different families and for different family members. It also takes a closer look at specific characteristics, such as income level, racial and ethnic identity, and immigrant status of families with children that may affect a family’s likelihood of having one or more uninsured members. Many of the social and economic characteristics associated with individual uninsurance are, not surprisingly, also related to family uninsurance. There is a summary section at the end of the chapter.