Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 1. Parent's Insurance Coverage

05/12/1999

Table 1 presents a distribution of parent's insurance coverage by the child's insurance coverage for each of three points in time: October 1992, September 1993, and September 1994 (representing the beginning, middle, and end of the two-year period FY93 through FY94). "Parent" here refers to the individual identified in the SIPP file as the child's parent. Thus the parental coverage reported in Table 1 refers to only one parent. There are characteristics reported in later tables for which we take account of both parents, if present, where the second parent is identified as the spouse of the first parent. For health insurance coverage, however, we felt that we could not easily combine the four-category reports of two parents to produce a summary measure of both parents' coverage.

Altogether 18 to nearly 21 percent of uninsured children have a parent who reports some insurance coverage, and 7 to 8 percent of uninsured children have a parent who reports being covered by Medicaid. Another 4 percent of children appear to have no parent in the household, so their parents' insurance coverage must be regarded as unknown--and perhaps irrelevant.

We suspect that much if not most of the parent-child discrepancy in reported Medicaid coverage is due to measurement error--either in the misreporting of the child as not covered by Medicaid or the misreporting of the parent as covered. There are very few circumstances under which a parent would qualify for Medicaid while a child under 19 would not. If a parent is eligible for Medicaid by virtue of receiving Supplemental Security Income (SSI), then the children are not automatically eligible. It is likely, however, that many children who are in this situation would be eligible for Medicaid on the basis of their family income, given that the one parent receiving SSI and his or her SSI payments would not be counted in the Medicaid eligibility determination. Another situation that could result in a parent being covered by Medicaid but not the child is where the child qualifies for consideration as an adult. In this case the child could be ineligible for Medicaid despite having a parent and one or more siblings who qualify. We doubt that such cases as these could be numerous enough to account for the estimated 7 to 8 percent of uninsured children who have a parent covered by Medicaid, however.

TABLE 1: PERCENTAGE DISTRIBUTION OF PARENT'S INSURANCE COVERAGE BY CHILD'S INSURANCE COVERAGE
Period and Child's Insurance Coverage Grand Total Subtotal Parent Is Insured Parent Is Uninsured No
Parent in
Household
Employer – sponsored Medicaid Other
October 1992              
All Children 71,549,000 84.5 65.1 15.3 4.2 13 2.5
    Insured 62,060,000 94.7 73.4 16.5 4.7 3.1 2.2
        Employer-sponsored 46,439,000 97.4 95.7 1.1 0.6 1.4 1.2
        Medicaid 12,614,000 83.8 6.2 76.7 0.9 9.7 6.4
        Other 3,007,000 97.3 10.7 1.9 84.8 1.3 1.3
Uninsured 9,489,000 18.3 10.4 7.4 0.5 77.8 3.9
September 1993              
All Children 70,868,000 84.3 64.3 15.9 4.1 13.3 2.4
    Insured 61,597,000 94.1 72.2 17.2 4.7 3.9 2.1
        Employer-sponsored 45,396,000 97.3 95.1 1.3 0.9 1.7 1
        Medicaid 13,369,000 82.7 7.6 74.5 0.6 11.6 5.7
        Other 2,831,000 96.6 10 1.2 85.4 1.8 1.6
Uninsured 9,271,000 19.8 12 7.4 0.4 75.9 4.3
September 1994              
All Children 69,935,000 84.6 64.4 16.2 4.1 13.2 2.2
    Insured 61,024,000 93.9 72 17.3 4.6 4.1 2
        Employer-sponsored 44,858,000 97.5 95.6 1.2 0.6 1.6 0.9
        Medicaid 13,259,000 81.4 6.1 75.1 0.3 13 5.6
        Other 2,907,000 96.6 8.9 2.1 85.5 1.9 1.5
Uninsured 8,911,000 20.6 11.8 8.4 0.3 75.4 4
SOURCE: Survey of Income and Program Participation, 1992 Panel.

If most of the reported instances of uninsured children with Medicaid-covered parents are indeed erroneous, we suspect that the reported lack of coverage of the child is where the problem lies. The Medicaid enrollment of children is underreported in the SIPP by 13 to 15 percent (see Technical Appendix D). Situations where Medicaid coverage is reported for a parent but not reported for all children may account for some of the underreporting among children. Certainly this possibility merits further investigation and, if borne out, could provide a basis for making a partial correction to the reported Medicaid coverage of children in the SIPP.

The 10 to 12 percent of uninsured children whose parents are reportedly covered by employer-sponsored insurance raise important questions as well. Could some of this, too, be due to error in the reporting of either the parent's coverage or the child's lack of coverage? If the parent is truly covered and the child is not, did the parent have no access to dependent coverage, or did the parent find it too expensive or otherwise choose not to obtain such coverage? These are not questions that SIPP data can answer, but they are questions that must be posed to other datasets and new data collection efforts if we are to understand the prevalence of uninsurance among children.

The 10 to 13 percent of Medicaid-covered children with uninsured parents is consistent with the expansion of Medicaid coverage aimed exclusively at children. That this percentage grows over time is also consistent with the newness of these expansions--participation in new programs tends to start slowly--and the fact that they have continued to make more and more children eligible over time.1

Finally, the consistent 6 percent of children with no parent in the household among children who are covered by Medicaid is noteworthy because it is three times as high as the rate at which all children under 19 appear to have no parents in the household. The rate among uninsured children is 4 percent or midway between the all-child rate and the Medicaid rate. This differential frequency of no-parent households among these different groups of children may reflect a causal impact of parental absence on both Medicaid participation and uninsurance. It is plausible, certainly, that the absence of parents from a child's household affects the likelihood that the child will qualify for Medicaid and, also, the likelihood that no private or other public insurance coverage will be provided.2 At the same time, however, the absence of a parent from the survey household may reduce the likelihood that all sources of insurance coverage for a child are reported. In other words, the apparent relationship between a child's uninsurance and the parents' absence from the child's household may be due in part to the child's insurance coverage being underreported when neither parent is present in the household.3 This might seem to be contradicted by the Medicaid finding, where children without parents are more likely than other children to be covered by Medicaid, but the mechanisms may be different.

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