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Analysis of Transition Events in Health Insurance Coverage

Publication Date

By: John L. Czajka and James Mabli Mathematica Policy Research

The number of people lacking health insurance coverage in the U.S. is sustained by a set of dynamic processes. Comparatively few of the uninsured remain in that state indefinitely, but uninsured persons who gain coverage are offset by insured persons who lose their coverage. In good economic times the balance shifts toward the gainers, and uninsured rates tend to decline. In weak times, the balance shifts in the reverse direction, and uninsured rates tend to rise. Migration plays a role as well. New immigrants have much higher uninsured rates than long-term residents, but so do those who leave the population, which dampens the effect of immigration. Achieving a significant reduction in the number of uninsured persons will require reducing the rate at which people lose coverage or increasing the rate at which people (re)gain coverage  or, ideally, both. From a policy perspective, this should focus attention on the factors that contribute to people losing or gaining coverage, yet true longitudinal analyses of these factors are rare.

The study had four main components: (1) a literature review; (2) methodological work on the 2001 panel of the Survey of Income and Program Participation (SIPP) to identify and address limitations that represent potential sources of bias in estimates of health insurance dynamics; (3) a descriptive (or tabular) analysis of SIPP panel data to document aspects of the dynamics of health insurance coverage and (4) a multivariate analysis of events associated with transitions in health insurance coverage. The literature review and the methodological findings are presented in appendices to the report and not discussed in this summary.

Executive Summary


The authors would like to acknowledge the contributions of several individuals to the preparation of this report. We are especially grateful to Julie Sykes, Daisy Ewell, and Sandi Nelson, who constructed the analysis files and produced most of the estimates presented herein. We also wish to acknowledge and express our sincere thanks to James Reschovsky, who reviewed the draft of this report; Laura Castner, who answered numerous questions about the data; and Alfreda Holmes, who prepared the final manuscript.

Finally, we want to thank our Task Order Monitor, Don Oellerich, in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, and Robert Stewart, his predecessor, now at the Congressional Budget Office, for providing helpful guidance throughout the project.

This report was prepared by Mathematica Policy Research, Inc. under contract to the Office of the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services (HHS). The findings and conclusions of this report are those of the authors and do not necessarily represent the views of ASPE or HHS.