Children's health insurance coverage and adequacy from 2016 to 2018: Racial/ethnic disparities under the ACA

Background: This study advances health disparities research by documenting the racial/ethnic disparities in children's health insurance coverage and health insurance adequacy under the implementation and revisions of the Affordable Care Act between 2016 and 2018 in America. Design and methods: Combining the nation-wide repeated cross-sectional data from 2016 to 2018 Children's Health National Survey (NSCH), we examined the changes and trends of health insurance coverage and health insurance adequacy among children age 0-17 across different racial/ethnic groups from 2016 to 2018. Multivariate logistic regression models stratified by race-ethnicity were further analyzed to examine the association between children's health insurance adequacy, their health insurance coverage, and their socio-demographic background factors. Results: Our analyses indicate that generally children's enrollment in Medicaid or other government aided health care programs had been increasing whereas children's enrollment in the employer-based had been decreasing from 2016 to 2018. At the same time, the number of children who said that they always had adequate health insurance to meet their health care needs has slightly dropped from 2016 to 2018, except for AIAN children. Our analyses further revealed that the risk of inadequate health insurance appears to be stronger for children in disadvantaged situation, socially and economically. Conclusions: The ACA has contributed to expanding childhood health insurance coverage. But racial/ethnic disparities continue to exist in children's health insurance coverage and health insurance adequacy. To achieve equity in childhood health care, more outreach and appropriate programs are needed for children who are socially and economically disadvantaged.