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Urban Institute: Low-income parents faced more hurdles to afford, receive healthcare in 2021


Parents in low-income households face greater challenges and hurdles in addressing health needs than other parents, according to a new analysis from the Urban Institute.

The research relied on health status, health insurance coverage, healthcare access and affordability and worries about other basic needs among parents with lower incomes as metrics. Researchers assessed three income groups, and, while they found challenges across various levels, parents with low incomes faced particularly steep barriers. 

In April 2021, parents with family incomes at or below 138% of the federal poverty level were disproportionately people of color. They were also (on average) younger, more likely to have young children and less likely to be married, the analysis found. “Thus, many were likely balancing considerable child care responsibilities with limited resources,” the report said. 

Parents in this category were also more likely to report physical and mental health struggles, with more than a quarter being in fair or poor health, compared to only about 4% of parents with incomes at or above 400% of the federal poverty level. Nearly half of parents with low incomes reported having a chronic health condition, versus about a third of those in the higher-income category, and about 40% reported having a mental or behavioral health condition (versus 20%). 

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The same month in 2021, parents with low incomes were more than nine times as likely to be uninsured—and less likely to have a usual source of healthcare or provider—than the higher-income category. They were also more than seven times as likely to report struggling to pay family medical bills. Finally, they were more likely to be worried about food insecurity as well as being able to pay expenses like rent or utilities in the next month.

“Challenges accessing and affording health care among parents with low incomes could compound the other hardships they were experiencing before the pandemic and that were likely exacerbated by the crisis,” the report stated.

While some federal relief was provided, it was temporary, it noted, and further actions are needed to address the health and well-being of low-income families.

Expanding and maintaining access to affordable health insurance coverage, paid leave and child care assistance and extending the expanded child tax credit and increasing take-up among low-income parents—many of which are currently under consideration by Congress in the Build Back Better legislation—are steps that could help address parents’ health and healthcare challenges, according to researchers.

The report also suggested that improving COVID-19 vaccination rates and virus containment measures could help address hardships and reduce disparities across income groups.



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