Children's Health Insurance Patterns:
A Review of the Literature

by
Kimball Lewis, Marilyn Ellwood, and John L. Czajka
Mathematica Policy Research Inc.

for the
Office of Health Policy
Office of the Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human Services
December 19, 1997

CONTENTS

ACKNOWLEDGMENTS
I INTRODUCTION
A. METHODOLOGY
B. OVERVIEW
II HOW MANY CHILDREN ARE UNINSURED?
A. MEASURING THE UNINSURED
B. CPS ESTIMATES OF THE UNINSURED
1. Census Bureau, CBO, GAO, and EBRI Estimates
2. The Urban Institute's Estimates
3. CPS Health Insurance Measurement Issues
C. SIPP ESTIMATES OF THE UNINSURED
1. Overview of the SIPP
2. Measuring Health Insurance Status Using the SIPP
3. SIPP Versus CPS Estimates of the Uninsured
4. Other SIPP Estimates of the Uninsured
D. OTHER ESTIMATES OF THE UNINSURED
1. National Health Interview Survey
2. Medical Expenditure Panel Survey
3. Community Tracking Study
4. Kaiser/Commonwealth Survey of Americans
E. STATE-LEVEL ESTIMATES
1. The Urban Institute
2. Families USA
III CHARACTERISTICS OF THE UNINSURED
A. STATIC CHARACTERISTICS OF THE UNINSURED
1. Age
2. Race and Ethnicity
3. Citizenship
4. Family Structure and Poverty Level
5. Parents' Employment and Health Insurance Status
6. Parents' Education
B. DYNAMICS OF THE UNINSURED
IV HOW MANY UNINSURED CHILDREN ARE ELIGIBLE FOR MEDICAID AND WHAT IS THE MEDICAID PARTICIPATION RATE FOR CHILDREN?
A. HOW MANY UNINSURED CHILDREN ARE ELIGIBLE FOR MEDICAID?
1. The Urban Institute
2. Reschovsky et al.
3. Thorpe
4. Estimates for Poverty-Related Expansion Children Only
B. WHAT IS THE MEDICAID PARTICIPATION RATE FOR CHILDREN?
1. The Urban Institute
2. Congressional Budget Office
3. SIPP Estimates of Medicaid Eligibility
4. Estimates for Poverty-Related Expansion Children Only
C. PARTICIPATION RATES IN OTHER PUBLIC ASSISTANCE PROGRAMS
V CHARACTERISTICS OF UNINSURED CHILDREN WHO ARE ELIGIBLE FOR MEDICAID
VI SUMMARY AND NEXT STEPS
REFERENCES

APPENDIX A: MARCH 1995 CPS HEALTH INSURANCE QUESTIONS (Not included in this version.)

APPENDIX B: 1993 SIPP HEALTH INSURANCE QUESTIONS (Not included in this version.)

APPENDIX C: 1996 NHIS HEALTH INSURANCE QUESTIONS (Not included in this version.)

APPENDIX D: 1996 MEPS HEALTH INSURANCE QUESTIONS (Not included in this version.)

(Selected Medicaid and Uninsured Questions Only) (Not included in this version.)

APPENDIX E: 1996/1997 CTS HEALTH INSURANCE QUESTIONS (Not included in this version.)

(Selected Medicaid and Uninsured Questions Only) (Not included in this version.)



TABLES

II.1 CPS ESTIMATES OF THE UNINSURED BY SOURCE

II.2 CPS AND HCFA(now known as CMS) ESTIMATES OF MEDICAID ENROLLMENT, NONELDERLY AND CHILDREN, 1992 TO 1995

II.3 SIPP ESTIMATES OF UNINSURED CHILDREN BY SOURCE

II.4 SIPP ESTIMATES OF UNINSURED FOR ALL PERSONS BY SOURCE

II.5 HEALTH INSURANCE STATUS OF ALL PERSONS: CPS VERSUS SIPP FOR VARIOUS YEARS 26

II.6 OTHER ESTIMATES OF THE UNINSURED

III.1 DISTRIBUTION OF ALL PRIVATELY INSURED, PUBLICLY INSURED, AND UNINSURED CHILDREN BY VARIOUS CHARACTERISTICS

III.2 DISTRIBUTION OF UNINSURED CHILDREN IN 1995 BY AGE

III.3 REASONS CHILDREN UNDER AGE 22 LOST HEALTH INSURANCE COVERAGE

IV.1 ESTIMATES OF THE NUMBER OF UNINSURED CHILDREN WHO ARE ELIGIBLE FOR MEDICAID BUT NOT PARTICIPATING, BY SOURCE

IV.2 ESTIMATES OF MEDICAID PARTICIPATION RATES FOR CHILDREN, BY SOURCE

ACKNOWLEDGMENTS

It became clear early on in the research for this report that many complex issues surround the process of estimating the health insurance status of America's children. We are indebted to various individuals and organizations who helped us to sort through and understand these issues. First and foremost, we would like to thank Laura Brice and Christy Schmidt of ASPE who supported this project and provided thoughtful guidance throughout its course. We would also like to thank the members of the advisory panel, who provided extremely helpful comments on the first draft of this report. The advisory panel members were: Linda Bilheimer of the Congressional Budget Office; Paul Fronstin of the Employee Benefit Research Institute; John Holahan of The Urban Institute; Gene Lewit of the Packard Foundation; and Kathy Swartz of the Harvard School of Public Health. Dave Baugh and Roger Buchanan of HCFA(now known as CMS) provided us with useful notes from their interviews of the various persons who have estimated the number of uninsured children. Shruti Rajan and Beth Kessler of The Urban Institute conducted simulations for us of Medicaid eligibles using the TRIM2 model. Jim Reschovsky of the Center for Studying Health Systems Change provided information about the Community Tracking Study data. At MPR, Jan Watterworth did the library research, Julie Sykes provided valuable comments, Marsha Gold reviewed an initial draft, Larry Radbill helped us with our description of the SIPP, and Melanie Lynch prepared the manuscript. The authors gratefully acknowledge the contributions of these individuals but accept full responsibility for any errors that remain.


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