Childhood Underinsurance in Primary Care: A Practice-Based Study

<b>Background/Objectives:</b> Health insurance coverage is critical for children's health, yet underinsurance remains a significant issue in the United States. This study aims to estimate the prevalence and correlates of childhood underinsurance in southwestern Ohio during a portion of the COVID-19 pandemic. <b>Methods:</b> This is a cross-sectional study of a convenience sample of children, ages 6 months to <18 years, seen in primary care pediatric practices. Recruitment of children's primary caregivers (PCGs) occurred in practice waiting rooms from June 2021 to April 2023. Respondents completed the Medical Expenses of Children Survey (MEoCS). Index children were considered underinsured if their PCG responded "yes" to any of six questions regarding the inability to pay for a child health clinician's recommendation despite the child having health insurance. Chi-squared tests and logistic regression were employed in data analysis. <b>Results:</b> 1252 PCGs completed the MEoCS with a response rate of about 90%. 11.3% of index children were underinsured. 41.5% of PCGs raising underinsured children found it harder to access care for their child compared to 3 years ago, while only 9.5% of PCGs raising adequately insured children reported it was harder (<i>p</i> < 0.001). PCGs of underinsured children were more likely to report that COVID-19 had a negative effect on their household income (49.2%) and their child's school performance (52.0%) and mental health (47.7%) compared to adequately insured children (27.0%, 27.0%, 25.0%; <i>p</i> < 0.001). <b>Conclusions:</b> About 1 in 9 index children were underinsured. Lower parental education and private health insurance were associated with underinsurance across several study cohorts, documenting the stability of these drivers of underinsurance.