Given the many transitional events that affect the life of a family and its chances to gain or lose health insurance, it is not surprising that so many families lack full coverage. When the choice of a spouse or job or the date of retirement can affect health coverage for oneself and others within the family, family decisions become more complex. Even families with the best of intentions and making the most rational choices cannot ensure that all of their members will be able to get and maintain coverage. Many of the factors affecting coverage are beyond the immediate control of the family, are unpredictable, and have no apparent rationale. Not all workers have a choice of a job with affordable employee and dependent coverage. Not all lower-income families are fortunate enough to live in a state with expansive public programs.

A common thread runs through most of the family transitions that result in the loss of coverage. Often, uninsurance results from a combined loss of income and loss of access to employment-based coverage.

The nature of these family transitions make it easier to understand the patterns discussed in the preceding chapter—why single-parent families are at greater risk of uninsurance and why, within the same family, children may be covered and parents not. The following chapters look at the impacts on families of not having all members insured. Nevertheless, it is also important to keep in mind that 81 percent of all families with children do have coverage for all their members. If they are lucky, they will be able to maintain that coverage until they all reach Medicare age.