to pay for needed care, their parents may decide to delay treatment and hope that a medical problem will resolve on its own. Health problems that are minor in their early stages can escalate to serious and costly medical emergencies, and delays in access to health care can increase the burden of suffering from disease. This is especially true for children with special needs and chronic diseases.

Things happen. Earaches happen. Toothaches happen. Not being in a position to be able to save up for that rainy day of emergency room visits or doctor visits, I have spent more than a few minutes wondering what would I do if something happened. It's a lot like driving a car with no brakes. You know there is a stop light ahead. You just pray for green, because you don't know what you'll do if you have to stop.

Maureen Ceidro

Parent and Former Participant, Caring Program of Western Pennsylvania

Public Workshop, June 2, 1997

Profile Of Health Insurance Coverage

Who Is Insured and Who Isn't

The U.S. health care system is often described as a patchwork of funding streams, often resulting in fragmentation of the delivery of care. Depending on the methods used to collect and analyze information from these funding streams, estimates of insurance coverage vary.

For example, estimates of Medicaid coverage from the Health Care Financing Administration differ substantially from those produced by the Bureau of the Census and the Agency for Health Care Policy and Research. However, because the Current Population Survey (CPS) from the Bureau of the Census is most commonly used by governmental and nongovernmental agencies in health insurance analyses, the committee relied principally on CPS data for the estimates of insurance coverage presented in this chapter.

CPS data show that the major sources of coverage for health care for the nation's 71 million children in 1995 included the following:

  • 41.7 million had employer-based coverage through their parents,
  • 16.5 million were enrolled in Medicaid,
  • 300,000 were Medicare beneficiaries,
  • 2.3 million had military health care (primarily Civilian Health and Medical Program of the Uniformed Services, or CHAMPUS), and
  • 9.8 million had no coverage.

Table 2.3 indicates the array of sources of health insurance coverage for children, and for purposes of comparison Table 2.4 indicates the same array for adults.

Trends in Coverage for Children

Figure 2.1 shows the trends in coverage for children from 1987 to 1995 as a percentage of all children (refer to Table 2.1 for the exact percentages). Employer-based coverage for children decreased 8 percent between 1987 and 1995 (see Figure 2.1). The decrease in employer-based coverage for children was

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