When parents were asked why their adolescent children were not covered by health insurance, most cited the high cost of coverage, or a job layoff or job loss.

"Despite the clear importance of health insurance, our study also shows that coverage is not evenly distributed within the adolescent population," Newacheck said. Four out of every five uninsured adolescents come from poor and "near poor" families -- those with incomes below 200 percent of the poverty level. Such families are six times more likely than more affluent families to have no health coverage for their teens.

Hispanics were the least likely to be covered, followed by blacks. The South and the West had the largest proportions of uninsured adolescents.

A new federal program to improve children's health insurance coverage offers an opportunity to reduce inequities, the authors say. The Balanced Budget Act of 1997 created the State Children's Health Insurance Program (SCHIP), which provides matching federal funds for states to expand health insurance coverage of children and adolescents up to age 19 from low income families with incomes below 200 percent of the poverty level.

"However, states will require aggressive outreach and enrollment efforts to take full advantage of the potential of SCHIP," Newacheck said. "Each state will design its own program, and Congress allocated no funds to evaluate programs or to compare program effectiveness across states. Adolescents are particularly challenging to enroll because traditionally they have fewer contacts with health care providers than younger children. The burden is on health care providers, especially pediatricians, and on all children's advocates to encourage the development of effective strategies so more American children and adolescents have adequate health insurance coverage."

Co-authors of the study were Paul W. Newacheck, DrPH
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Contact: Janet Basu
jbasu@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
2-Aug-1999