ANALYSIS OF CHILDREN'S HEALTH INSURANCE PATTERNS:
FINDINGS FROM THE SIPP
CONCLUSION
Examining the dynamics of health insurance coverage among children tells
us much about the magnitude of the task of insuring the uninsured. While
policymakers and researchers tend to focus on the number of children who
are without insurance at any one time, children who experience one or more
months without insurance over the course of a two-year period are more
than double this number. Most children who become uninsured remain uninsured
for less than six months at a time, so growth in the number of uninsured
children has remained modest. Nevertheless, policymakers' well-warranted
concerns about the difficulty of enrolling a high proportion of eligible
children--especially those who have not participated in Medicaid previously--bring
the problem into focus. Turnover in the population of uninsured children
implies that outreach efforts will have to continue at a high level in
order to achieve and maintain strong participation in Medicaid and CHIP.
Retention of children who have already enrolled in Medicaid or CHIP
emerges as a potentially important policy issue. More than half of the
children who leave Medicaid are uninsured the next month, and such children
account for two-fifths of the newly uninsured. Why do they leave Medicaid,
and if access to insurance continues to be a need, what can be done to
keep them enrolled?
Despite a widespread perception to the contrary, participation in Medicaid
by eligible children with no other insurance was quite high before welfare
reform, and many of those who appeared to be uninsured and eligible for
Medicaid were actually in transition--often to Medicaid. But participation
rates were lifted by the high proportion of cash assistance recipients.
As this group declines in importance the historically much lower participation
rates of other groups of eligibles may become more typical. As CHIP extends
affordable health insurance coverage to increasingly more children, the
greatest challenge for policymakers is to ensure that no child who needs
this coverage is denied it.