Inadequate health coverage is a particular problem for commercially insured children, according to a new study released by Columbia University Mailman School of Public Health. The research shows that coverage gaps are affecting publicly insured children as well. Until now, prior research had focused on documenting rates and trends in insurance consistency for children covered by all insurance types. The findings are published in JAMA Health Forum.
“While uninsurance among children has generally been declining in the U.S., our results highlight the need for a renewed focus on making sure that children’s coverage is affordable for families and provides the benefits that children need” said Jamie Daw, PhD, assistant professor of health policy and management at Columbia Mailman School of Public Health.
Using representative data from the 2016-2021 National Survey of Children’s Health, the researchers analyzed parent- or caregiver-reported information on health insurance data for children from age 0-17 and also compared changes during COVID-19, identifying inconsistent and inadequate coverage within each insurance type. 
Inadequate insurance was defined by failure to meet three criteria: benefits were sufficient to meet a child’s needs; coverage allows a child to see needed health care providers; and a lack of reasonable annual out-of-pocket payments for child’s health care. 
Inconsistent coverage was three times higher among publicly compared to commercially-insured children. However, inadequate insurance was more prevalent overall, affecting nearly 1 in 5 U.S. children (16.5 million annually), with particularly high rates among the commercially-insured. The researchers also found that the child and family characteristics associated with higher rates of inconsistent and inadequate coverage differed by insurance type.
Of the sample of 203,691 insured children,34.5% were publicly-insured and 65.5 percent were commercially-insured. Compared to commercially-insured children, publicly-insured children had higher rates of inconsistent coverage (4.2 vs. 1.4 percent,) and lower rates of inadequate coverage (12 vs 33 percent). Relative to 2016-19, inconsistent insurance decreased by 42 percent for publicly-insured children and inadequate insurance decreased by 6 percent, for commercially-insured children during COVID. 
In summary, the findings indicate: 
– 1 in 5 children in the U.S. have inadequate health insurance, i.e. insurance that either has unreasonable out-of-pocket costs or doesn’t have benefits that meet the child’s medical needs. (
– Inadequate coverage is particularly high among kids with commercial insurance (approximately 1 in 3 commercially insured vs. 1 in 10 publicly insured kids).
– Insurance gaps (i.e. periods without coverage) are more common for publicly insured children.
– Both commercial insurance adequacy and public insurance gaps decreased significantly during the COVID-19 pandemic when there were additional subsidies for commercial insurance and requirements for states to keep Medicaid beneficiaries enrolled. 
-With protections winding down in 2023 following COVID, many publicly insured children are losing coverage which will reverse the gains in consistent coverage that were seen during the pandemic. 
-More needs to be done to protect commercially insured families against high out-of-pocket costs for child’s health care and make sure that benefits/provider networks are sufficient to meet children’s needs. 
Also, Daw and colleagues note there is a particular need for state Medicaid programs to conduct targeted outreach and linguistically and culturally competent navigation assistance for immigrant families.
“Federal COVID-19 relief policies prevented states from disenrolling children on Medicaid and instituted enhanced subsidies for private Marketplace coverage. Our study findings suggest these policies made an important difference for families during the pandemic: publicly insured children had fewer coverage gaps and coverage was more affordable for commercially insured children. Policymakers should be actively considering how to maintain and build on these gains,” noted Daw.
Co-authors are Sarra Yekta, Columbia Mailman School of Public Health; Faelan Jacobson-Davies and Lindsay Admon University of Michigan; and Stephen Patrick, Vanderbilt University Medical Center
The study was funded by the Agency for Healthcare Research and Quality (R01HS029159). 

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Ned Blackhawk spoke about Native American scholarship and archives on November 17 at an event sponsored by Columbia’s Lehman Center for American History. Two days earlier, he had won the National Book Award for Nonfiction for The Rediscovery of America: Native Peoples and the Unmaking of U.S. History.

“Was it earlier this week, or earlier this morning?” joked Blackhawk, the Howard R. Lamar Professor of History and American Studies at Yale University. He remained visibly moved by the accolade. “That happened less than 48 hours ago, and I still can’t process it. It’s been a pretty eventful week.”

A member of the Te-Moak Tribe of Western Shoshone Indians of Nevada, Blackhawk said that he hopes excitement around the prize will encourage more people to engage with Indigenous stories. “I know it’s a lot easier to just do other things,” he said. “Native American history is not familiar; it’s a little discomforting. But it’s a beautiful field, if you come to see it, because the insights can be quite generative, and often challenging. They make us think differently about things like citizenship, freedom, liberty.” 

A New Overview of U.S. History 

The Rediscovery of America offers an overview of U.S. history, from first contact to the 21st century, with Indigenous figures at the center. Among those he examines are Laura Cornelius Kellogg, an Oneida woman and one-time Barnard College student, who helped found the Society of American Indians, and Ada Deer, a graduate of Columbia’s School of Social Work, who served as assistant secretary of the Interior for Indian Affairs. 

The Lehman Center for American History, which is a collaboration between the Rare Book and Manuscript Library and the Department of History, invited Blackhawk as part of an ongoing conversation on Native American history. Previous events in the series have included a book talk by Columbia History Professor Michael Witgen, and a panel discussion on Black and Native Citizenship: The Making of American Identity Past and Present.

Despite years of study in Indigenous histories, there is an acute need for further research, particularly in the New York area. “There is an intense interest,” said Blackhawk. “A lot of people are asking me what I know about the Lenape communities that were in these spaces. But given the lack of sources, or scholarly studies, it’s hard to make sense of it all. You can’t just Google it.”

Going Back to the Archival Sources

To pursue this information, scholars are looking again at archival sources, including documents held by the RBML. From early audio recordings and printed books, to ethnographic records collected by Columbia anthropologists, the RBML serves as a custodian for a wide variety of Native American materials.

These collections were acquired by Columbia’s libraries decades—and sometimes more than a century—ago. They were often improperly identified and misinterpreted, and in the years since, have frequently served to reinforce colonial perspectives. Recent initiatives have begun correcting some of these historical legacies, and library staff now emphasize collaboration with creator communities. “Archivists have an ethical duty of stewardship to collections that reflect Indigenous people,” said Kevin Schlottmann, RBML head of archives processing. “This means making sure the existence of these records is known to tribes, that sustained community consultation takes place, that requests for restrictions on traditional or sacred knowledge are taken seriously, and that, when appropriate and desired, original records or digital reproductions are repatriated.”

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