Health Insurance and Youths’ Unmet Health Care Needs

Using the 2016 National Survey of Children’s Health to Inform Social Work Policy


  • Sarah J. Faubert Western Michigan University School of Social Work
  • Bridget E. Weller Western Michigan University School of Social Work
  • Anna K. Ault



health insurance, unmet health care need, youth, social policy, ACA


This study examined the relationship between youth health insurance status, insurance type (public versus private), and youths’ unmet health care needs. A secondary analysis was conducted using data from the 2016 National Survey of Children’s Health, a nationally representative, cross-sectional survey of U.S. youth. The sample included data from caregivers of 40,723 Hispanic, non-Hispanic black, and non-Hispanic white youth (0-17 years old) and was 49% female. Mplus 8.2 was used and statistical models accounted for the complex survey design. Using unweighted and weighted descriptive statistics and weighted probit regression models, we found that youth without health insurance were significantly more likely to have unmet health care needs compared to those with either public or private health insurance. We further found no statistically significant difference in unmet needs between youth with public and private health insurance. Our findings suggest that increased access to health insurance coverage, regardless of insurance type, may be an important policy focus when addressing youths’ unmet health care needs. Our findings can be used to guide future social work advocacy regarding health insurance policy.


Bagley, N. (2016). A legal setback for the Affordable Care Act. New England Journal of Medicine, 374(24), 2304-2307. doi:

Blair, L. M. (2016). Publicly-available data and pediatric mental health: Leveraging big data to answer big questions for children. Journal of Pediatric Health Care, 30(1), 84-87. doi:

Blumberg, L. J., Holahan, J., Karpman, M., & Elmendorf, C. (2018). Characteristics of the remaining uninsured: An update. Washington, D.C.: Urban Institute. Retrieved from

Butler, A. M., Weller, B., & Titus, C. (2015). Relationships of shared decision making with parental perceptions of child mental health functioning and care. Administration and Policy in Mental Health and Mental Health Services Research, 42(6), 767-774. doi:

Centers for Disease Control and Prevention. (2019). About the National Health Interview Survey. Retrieved from

Child and Adolescent Health Measurement Initiative [CAHMI], Data Resource Center for Child and Adolescent Health. (2018). 2016 National Survey of Children’s Health: Child and Family Health Measures and Subgroups, SPSS Codebook, Version 2.0. Retrieved from

Clemans-Cope, L., Kenney, G., Waidmann, T., Huntress, M., & Anderson, N. (2015). How well is CHIP addressing health care access and affordability for children? Academic Pediatrics, 15(3), S71-S77.


Crone, S. F., & Finlay, S. (2012). Instance sampling in credit scoring: An empirical study of sample size and balancing. International Journal of Forecasting, 28(1), 224-238. doi: https://doi:10.1016/j.ijforecast.2011.07.006

DeRigne, L. A., Porterfield, S., & Metz, S. (2009). The influence of health insurance on parent’s reports of children’s unmet mental health needs. Maternal and Child Health Journal, 13(2), 176-186. doi:

Devoe, J. E., Tillotson, C. J., Wallace, L. S., Selph, S., Angier, H., Devoe, J. E., … Angier, H. (2011). Comparing types of health insurance for children: A public option versus a private option. Medical Care, 49(9), 818-827.


Eltorai, A. E. M., & Eltorai, M. I. (2017). The risk of expanding the uninsured population by repealing the Affordable Care Act. Journal of the American Medical Association, 317(14), 1407-1408. doi:

Federico, S. G., Steiner, J. F., Beaty, B., Crane, L., & Kempe, A. (2007). Disruptions in insurance coverage: Patterns and relationship to health care access, unmet need, and utilization before enrollment in the state Children’s Health Insurance Program. Pediatrics, 120(4), e1009-e1016. doi:

Feldman, H. M., Buysse, C. A., Hubner, L. M., Huffman, L. C., & Loe, I. M. (2015). Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. Journal of Developmental and Behavioral Pediatrics, 36(3), 207-217. doi:

Flores, G., Lin, H., Walker, C., Lee, M., Currie, J. M., Allgeyer, R., … Massey, K. (2017). The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study. BioMed Central Public Health, 17(1), 1-14. doi:

Fry-Bowers, E. K. (2015). The ACA and insurance implications for children with special health care needs. Journal of Pediatric Health Care, 29, 212-215.


Glewwe, P., West, K. L., & Lee, J. (2018). The impact of providing vision screening and free eyeglasses on academic outcomes: Evidence from a randomized trial in Title I elementary schools in Florida. Journal of Policy Analysis and Management, 37(2), 265-300. doi:

Guerrero, A. D., Zhou, X., & Chung, P. J. (2018). How well is the medical home working for Latino and Black children? Maternal and Child Health Journal, 22(2), 175-183. doi:

Hox, J. J., & Maas, C. J. M. (2001). The accuracy of multilevel structural equation modeling with pseudobalanced groups and small samples. Structural Equation Modeling: A Multidisciplinary Journal, 8(2), 157-174.


Kaiser Family Foundation. (2019). Status of state action on the Medicaid expansion decision. San Francisco, CA. Retrieved from

Karaca-Mandic, P., Choi-Yoo, S. J., Lee, J., & Scal, P. (2014). Family out-of-pocket health care burden and children’s unmet needs or delayed health care. Academic Pediatrics, 14(1), 101-108. doi:

Kreider, A. R., French, B., Aysola, J., Saloner, B., Noonan, K. G., & Rubin, D. M. (2016). Quality of health insurance coverage and access to care for children in low-income families. JAMA Pediatrics, 170(1), 43-51.


Levitt, L. (2017a). Is the Affordable Care Act imploding? Journal of the American Medical Association, 317(20), 2051-2052.

Levitt, L. (2017b). What might an ACA replacement plan look like? Journal of the American Medical Association, 317(8), 795-796.


Lindly, O. J., Chavez, A. E., & Zuckerman, K. E. (2016). Unmet health services need among US children with developmental disabilities: Associations with family impact and child functioning. Journal of Developmental and Behavioral Pediatrics, 37(9), 712-723. doi:

Miller, J. E., Nugent, C. N., Gaboda, D., & Russell, L. B. (2013). Reasons for unmet need for child and family health services among children with special health care needs with and without medical homes. PLoS ONE, 8(12), 1-11.


Mulligan, J. (2017). The problem of choice: From the voluntary way to Affordable Care Act health insurance exchanges. Social Science and Medicine, 181, 34-42.


Muthén, L. K., & Muthén, B. O. (1998-2018). Mplus user’s guide (8th ed.). Los Angeles, CA: Authors.

Ortega, A. N., McKenna, R. M., Chen, J., Alcalá, H. E., Langellier, B. A., & Roby, D. H. (2018). Insurance coverage and well-child visits improved for youth under the Affordable Care Act, but Latino youth still lag behind. Academic Pediatrics, 18(1), 35-42. doi:

Princeton University. (2019). About the Fragile Families and Child Well-Being Study. Retrieved from

U.S. Census Bureau. (2018). 2016 National Survey of Children’s Health methodology report. Washington, DC. Retrieved from

U.S. House of Representatives v. Burwell, 185 F. Supp. 3d 165 (D.D.C. 2016).

Vittinghoff, E., & McCulloch, C. E. (2006). Relaxing the rule of ten events per variable in logistic and Cox regression. American Journal of Epidemiology, 165(6), 710-718. doi:

Weller, B. E., Blanford, K. L., & Butler, A. M. (2018). Estimated prevalence of psychiatric comorbidities in U.S. adolescents with depression by race/ethnicity, 2011-2012. Journal of Adolescent Health, 62(6), 716-721.


Wilensky, G. R. (2019). Medicare for all. The Milbank Quarterly, 97(2), 391-394. doi:

Zickafoose, J. S., & Davis, M. M. (2013). Medical home disparities are not created equal: Differences in the medical home for children from different vulnerable groups. Journal of Health Care for the Poor and Underserved, 24(3), 1331-1343.