Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 1. Spells of Uninsurance

05/12/1999

Table 5 presents for spells of uninsurance of various durations a cross-tabulation of insurance coverage in the month before the spell began by insurance coverage in the month after the spell ended (that is, the first month of coverage). Separate tabulations are reported, first, for all spells completed in 1 to 12 months, followed by tabulations of spells completed in 1 to 4 months, 5 to 8 months, and 9 to 12 months. A tabulation of spells completed in 13 to 18 months, derived from spells that started in just the first half of FY93, is reported at the bottom of the table. We did not pool this subset of spells with those completed in 12 months or less because the spells of longer duration would be underrepresented in the pooled tabulation.5

  Insurance Coverage After Completion of Spell
Insurance Coverage Before Start of Spell Employer- sponsored Medicaid Other Not in Universe Total
TABLE 5: INSURANCE COVERAGE BEFORE AND AFTER COMPLETED SPELLS OF UNINSURANCE BEGINNING IN FY93, BY DURATION OF SPELL
  All Spells Completed in 12 Months or Less
Employer-sponsored 41.8 9.4 2.6 0.3 54.1
Medicaid 8.5 28.3 0.9 1.1 38.8
Other 2 1 1.5 0 4.5
Not in Universe 0.6 1.7 0.1 0.1 2.5
Total 52.9 40.5 5.1 1.6 100
  Spells Completed in 1 to 4 Months
Employer-sponsored 43.7 8.9 1.8 0.4 54.7
Medicaid 8.2 28.7 1 1.6 39.5
Other 1.5 0.7 1.5 0 3.6
Not in Universe 0.4 1.5 0.1 0.2 2.2
Total 53.7 39.8 4.4 2.1 100
  Spells Completed in 5 to 8 Months
Employer-sponsored 39.6 10.8 5.1 0.4 55.9
Medicaid 5.3 28.5 0.4 0 34.1
Other 2.9 1.6 2.1 0 6.5
Not in Universe 1.8 1.6 0 0 3.4
Total 49.5 42.5 7.6 0.4 100
  Spells Completed in 9 to 12 Months
Employer-sponsored 35 10 2.4 0 47.4
Medicaid 16.2 26 1.1 0.5 43.9
Other 3.3 1.7 0.8 0 5.8
Not in Universe 0 3 0 0 3
Total 54.5 40.7 4.3 0.5 100
  Spells Completed in 13 to 18 Months*
Employer-sponsored 21.8 18.6 8.2 3.5 52.1
Medicaid 9.7 38.2 0 0 47.9
Other 0 0 0 0 0
Not in Universe 0 0 0 0 0
Total 31.5 56.8 8.2 3.5 100

* These spells are limited to those beginning in the first six months of FY93.

SOURCE: Survey of Income and Program Participation, 1992 Panel.

The estimates reported in each subtable are percentages of the total number of spells in each duration group. Thus the percentages in the total column at the right give the distribution of insurance coverage prior to the spell of uninsurance; the percentages in the total row beneath each subtable give the distribution of insurance coverage after the spell of uninsurance; and the percentages inside the row and column margins give the distribution of spells by combinations of prior and subsequent insurance coverage.

For all spells of uninsurance completed in 12 months or less, 54 percent were preceded by employer-sponsored coverage, 39 percent were preceded by Medicaid, 4.5 percent were preceded by another form of coverage, and 2.5 percent were experienced by children who were not in the survey universe prior to the spell. These last would be newborns who were without health insurance at birth. The distribution of sources of coverage following a spell of uninsurance is very similar to the distribution prior to the spell, with 53 percent being covered by an employer-sponsored plan, 40 percent by Medicaid, 5 percent by another type of plan, and 1.6 percent leaving the survey universe.6

In October 1992, based on these same data, about 19 percent of insured children were covered by Medicaid, 76 percent by an employer-sponsored plan, and 5 percent by another type of plan. Thus the frequency of Medicaid as the source of coverage before and after a spell of uninsurance lasting 12 months or less is more than double the frequency of Medicaid among all insured children. Coverage other than Medicaid or an employer-sponsored plan occurs with about the same frequency among all insured children as among those who later or previously experienced spells of uninsurance, while employer-sponsored coverage occurs with lower frequency before or after a spell of uninsurance than it does among all insured children.

The similarity of the distributions of sources of coverage before and after spells of uninsurance does not necessarily mean that children end their spells of uninsurance by returning to the same coverage that they lost to begin their spells, but we see from the cross-tabulation of coverage before and after uninsurance that the two sources are clearly not independent. For all spells of uninsurance completed in 12 months or less, 28 percent were preceded and followed by Medicaid enrollment, and 42 percent were preceded and followed by employer-sponsored coverage. About 9 percent of children changed from employer-sponsored coverage to Medicaid, and somewhat fewer children made the reverse transition.

Among spells completed in 12 months or less, we see little variation in these basic patterns by duration. But spells completed in 13 to 18 months present a very different picture, showing an even greater prominence of Medicaid. Prior to a spell lasting 13 to 18 months, 48 percent of the children were insured by Medicaid and 52 percent by an employer-sponsored plan. We found no incidence of other sources of coverage and no children who remained uninsured for 13 months past their births. Following a spell of 13 to 18 months, 57 percent of children enrolled in Medicaid compared to 32 percent becoming covered by an employer-sponsored plan. Medicaid was the source of coverage both before and after a long spell of uninsurance among 38 percent of the children who experienced such spells. Employer-sponsored coverage preceded and followed 22 percent of these spells--barely half the percentage among shorter spells. Children who left a spell of uninsurance that was preceded by employer-sponsored coverage were almost as likely to end their spells by acquiring Medicaid coverage as employer-sponsored coverage, and other coverage was nearly half as common as Medicaid. A possible explanation for the differential importance of Medicaid by duration is that parents who lose employer-sponsored coverage tend to defer pursuing other coverage for their children because they expect to regain employer-sponsored coverage. If they are unable to regain employer-sponsored coverage within a year or so, they try to obtain Medicaid. It could be, as well, that many of these children did not qualify for Medicaid in the months after employer-sponsored coverage was lost and became eligible only after their parents spent down savings and other resources.

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