The COVID-19 pandemic has added hardships and stress to the burdens parents face in meeting their families’ needs. Parents with low incomes, in particular, have faced greater difficulties meeting their and their families’ basic needs than other parents. In this report, we use data from the April 2021 Health Reform Monitoring Survey to assess health status, health insurance coverage, health care access and affordability, and worries about other basic needs in spring 2021 among nonelderly parents. We examine these outcomes among three income groups: at or below 138 percent of the federal poverty level (FPL); 139 to 399 percent of FPL; and at or above 400 percent of FPL. We find that though parents at various income levels faced health challenges and problems accessing and affording health care, parents with low incomes faced particularly steep challenges. Our main findings are as follows:

• Compared with parents with higher family incomes, parents who had family incomes at or below 138 percent of FPL (about $30,000 per year for a family of three) were, on average, younger, more likely to have young children under age 6, and less likely to be married. Thus, many were likely balancing considerable child care responsibilities with limited resources. In addition, parents with family incomes at or below 138 percent of FPL were disproportionately people of color.
• Parents with incomes at or below 138 percent of FPL were more likely than those with higher incomes to report physical and mental health problems in spring 2021. Among such parents, an estimated 26.4 percent reported being in fair or poor health, 48.3 percent reported having one or more chronic conditions, and 40.9 percent reported having a mental or behavioral health condition. These shares were 3.9 percent, 34.8 percent, and 20.0 percent for parents with incomes at or above 400 percent of FPL.
• In April 2021, parents with incomes at or below 138 percent of FPL were more than nine times more likely to be uninsured than those with incomes at or above 400 percent of FPL (21.0 versus 2.3 percent). Those with incomes between 139 and 399 percent of FPL were more than five times more likely to be uninsured than those with incomes at or above 400 percent of FPL (12.1 versus 2.3 percent). Compared with parents with higher incomes, parents with incomes at or below 138 percent of FPL were also less likely to have a usual source of health care, and those with a usual source of care were less likely to have a usual provider.
• Parents with incomes at or below 138 percent of FPL (29.7 percent) were more than twice as likely as those with incomes between 139 and 399 percent of FPL (15.5 percent) and more than seven times more likely than those with incomes at or above 400 percent of FPL (4.2 percent) to report problems paying family medical bills.
• An estimated 61.5 percent of parents with incomes at or below 138 percent of FPL reported delaying or forgoing some type of health care in the past 12 months because of the cost, difficulties taking time off work, difficulties balancing family or child care obligations, or transportation challenges. Among parents with incomes between 139 and 399 percent of FPL and those with incomes at or above 400 percent of FPL, 37.5 percent and 18.8 percent delayed or forwent care for these reasons. Thus, parents with incomes at or below 138 percent of FPL were more than three times more likely than those with incomes at or above 400 percent of FPL to report such challenges. In April 2021, about one in four parents reported avoiding care over concerns about coronavirus exposure during the prior year; rates were similar across income groups.
• Parents with incomes at or below 138 percent of FPL were also more likely than those with higher incomes to be worried about experiencing other financial and material hardships; 1 in 3 reported being very or somewhat worried about having enough to eat, and more than 4 in 10 reported being very or somewhat worried about being able to pay their rent or mortgage, utilities, or debts in the next 30 days.

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. Federal relief assistance and supports were provided to reduce some pandemic- and recession-related hardships, and provisions requiring states to maintain Medicaid enrollment allowed many lower-income families to remain covered by health insurance. But hardships have remained and much of that assistance was temporary. Further actions would be required to help parents, particularly those with low incomes, address the challenges they are facing in ensuring the health and wellbeing of their families.

This report was updated May 26, 2022, to acknowledge the Robert Wood Johnson Foundation's funding of the April 2021 Health Reform Monitoring Survey.