The Key to Insuring Children

In awarding “performance bonuses” last December to twenty-three states that signed up 1.2 million children for Medicaid and the Children’s Health Insurance Program (CHIP), the Obama administration claimed that the expansion of the welfare state advances the well-being of children. Yet if the interests of children are really a priority, why is the current administration ignoring an underlying factor that leaves children most at risk of being uninsured: the retreat from marriage by their parents? According to a study by two Oklahoma sociologists, children living with married parents are significantly more likely to have private health-care insurance than are their peers whose biological parents are not married.

Loretta Bass of the University of Oklahoma and Nicole Warehime of Oklahoma Baptist University examined data of the Fragile Families and Child Well-being Study, measuring the relationship between family structure and child health outcomes at age 5. The researchers looked at data—collected for children born to 1,186 married mothers and 3,712 unmarried mothers between 1988 and 2000—to explore the effects of parental marital status on three measures: the child’s health insurance type, the child’s having a routine medical doctor, and the child’s being reported in excellent health.

While the percentages of all children having a medical doctor (74 percent) and being reported in excellent health (64 percent) were relatively high, children of married parents had the highest percentages (84 percent and 68 percent, respectively). While these differences may not seem striking, children were significantly more likely to be covered under private health insurance, and less likely to be on Medicaid, if their biological parents were married than if their parents were in the three other parental-relationship categories (cohabiting with each other; are romantically involved; or are not romantically involved). The correlation was robust and pronounced (p<0.001 for all three relationship categories), and remained so in the statistical model that controlled for demographic factors, including mother’s race, age, and education. In the controlled model, children of cohabiting parents were more than seven times to have no private insurance and almost four times more likely to receive Medicaid benefits, than their peers with married parents.

Similar results were found on the question of having a routine medical doctor. Children of married parents were significantly more likely to have a routine medical doctor than were their peers with parents from the other three categories. Although the magnitude of the relationship was attenuated in the controlled statistical model, the coefficients remained statistically significant.

Commenting on their findings, the Oklahoma scholars not only claim “that family structure matters” but also that “policymakers should note the importance of biological parents’ relationships in shaping children’s access to health insurance.” Given this admonition, perhaps the Obama administration should award performance bonuses to states not on the basis of increasing welfare dependency but rather on the basis of increasing the percentage of children living with married parents.

(Loretta E. Bass and M. Nicole Warehime, “Family Structure and Child Health Outcomes in the United States,” Sociological Inquiry 81.4 [November 2011]: 527–48.)