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of the three major coverage groups: private coverage, Medicaid, and uninsured. However, in California, Asian-Americans comprise approximately 20 percent of the population and approximately 12 percent of the uninsured children (Children Now, 1997).
Many, but not all, of these differences by race and ethnicity correspond to differences in parental employment and thus relate to family income. An analysis of the data from the National Medical Expenditure Survey found that poverty, minority status, and absence of insurance each had independent effects on access to and the use of primary care, but that there was overlap among the groups: among children in at least one of these at-risk groups, 40 percent also had another risk factor. In other words, children who are uninsured are more likely to be poor and to be from a racial or ethnic minority (Newacheck et al., 1996).
Along with the growing diversity of the American population throughout all regions of the country, the availability of culturally appropriate health care services also varies. However, in designing new children's insurance expansions, it will be important to have current information on the racial and ethnic distributions of children by insurance status at the state level and local levels. Without such information, it will be more difficult to focus appropriate outreach and enrollment efforts on the communities with the highest concentrations of uninsured children.
Family Structure and Parental Employment
Figures 2.8, 2.9, and 2.10 present the breakdowns of household living arrangements, parents' employment status, family income, and parents' education status for children who have employer-based coverage and Medicaid, and for those who are uninsured, respectively.
Not surprisingly, the majority of children with employer-based coverage live in two-parent, working families (see Figure 2.8). More than half (54 percent) live in families with incomes that are 300 percent of the federal poverty level or higher. Children with Medicaid coverage are more likely to live in single-parent families (61.5 percent) in which the family income is 133 percent of the federal poverty level or less (71.8 percent) (see Figure 2.9 for Medicaid breakdowns, and see also Table 2.5 for breakdowns of federal poverty thresholds by family size).
The majority of uninsured children live in two-parent, working families (see Figure 2.10). Thus, parents of most uninsured children have been described as being among the ''working poor." Almost half of uninsured children (48 percent) live in families whose incomes are below the 133 percent of the federal poverty level ($20,706.77 for a family of four in 1995).
More than half (55 percent) of the uninsured children have parents who finished high school. The majority of children who are uninsured (64 percent) live in families in which someone works full time year-round, typically in service industries, seasonal work, or other low-wage jobs in small businesses.
Evidence suggests that the majority of workers who are offered insurance coverage through their employer will enroll (Nichols et al., 1997). Small employers are less likely to offer health insurance to their workers than are large employers, and small employers tend to provide less-comprehensive benefits than do large employers (Nichols et al., 1997). However, the available evidence shows no clear relationship between firm size and the size of employees' contributions for dependent coverage (Nichols et al., 1997), suggesting that employers consider more than just the number of their employees in designing their benefits and cost-sharing requirements.
Duration Of Lack Of Coverage
According to data from the Census Bureau's Survey of Income and Program Participation, millions of children spent several months without coverage between 1992 and 1994. Only 12 percent of uninsured children lacked coverage for 3 months or less. Nearly 40 percent were without coverage for 4 to 9 months, and half (50 percent) were without coverage for 10 months or more (see Figure 2.11).