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

05/12/1999

In Table 24 we see that among infants in September 1993, 16.4 percent were ever uninsured during their infancy. Among those who were ever uninsured the average number of months without insurance was 4.87, and 9.6 percent of these children were uninsured for all 12 months. The proportion of all infants who were uninsured for the entire year of their infancy was 1.6 percent. From the average duration of uninsurance we could calculate the probability that an infant who was ever uninsured during the year was uninsured at a point in time. This is simply the average number of months uninsured divided by 12. Multiplying this probability (.406) by the percentage ever uninsured during the year gives us the average percentage of all infants--6.7 percent--who would have been uninsured at a point in time. For 18-year-olds this same calculation would yield 17.3 percent as the proportion likely to have been uninsured at a point in time.

The percentage of children ever uninsured during the year shows a progressive rise from age 0 to 18, reaching 26.9 percent among 18-year-olds. The average duration of uninsurance rises as well but not as steeply as the percentage of ever-uninsured children who were uninsured for the entire year. This latter approaches 40 percent among the oldest children whereas it is less than 10 percent among infants and just over 20 percent in the next higher ages. (These estimates show marked variability among neighboring ages, which we attribute primarily to sampling error.) The percentage of all children uninsured for 12 months rises even more dramatically because it is the product of two percentages that rise with age: the percentage ever uninsured and the percentage among these who were uninsured the entire year. From a low of 1.6 percent among infants and 4.0 percent among children one year of age the proportion uninsured for all 12 months rises to just over 10 percent among children age 18.

Turning to Medicaid eligibility within spells of uninsurance, we find very different patterns by age than we do for uninsurance generally. In Table 25 we see that just under 11 percent of all children were ever Medicaid-eligible and uninsured during the year. This fraction is 13 percent among infants, and it remains at about that level until age 10, when it drops to between 7 and 8 percent. Eligibility under the poverty-related criteria did not extend to children who were age 10 in September 1993; children 10 and older at that point could qualify for Medicaid through a number of other channels, but the unavailability of coverage through the poverty-related criteria limited eligibility to barely more than half the number who were eligible at younger ages.

That the probability of being both uninsured and Medicaid-eligible varies so little by age can be explained by the fact that Medicaid eligibility rates decline with age while the probability of being uninsured rises. With these two rates moving in opposite directions their product tends to remain nearly constant. By the same reasoning, however, we would expect the probability of being uninsured and not eligible for Medicaid to rise sharply with age. Both the probability of being uninsured and the probability of being ineligible for Medicaid increase with age. Hence the age pattern will be amplified when these two statuses are combined.

The average number of months that children were uninsured and Medicaid-eligible did not vary by age, it appears.12 Children remained in this state for an average of nearly five months at every year of age. We suggest that the uniformity of this experience by age may be due to the fact that, unlike spells of uninsurance without Medicaid eligibility, parents could choose to end a spell of Medicaid-eligible uninsurance by enrolling the child in Medicaid. There is no obvious reason why the age of the child should affect how long parents choose to wait, except perhaps for infants, although spells for infants were no shorter than spells for older children.

The proportion of ever-uninsured (and Medicaid-eligible) children who were uninsured for all 12 months shows very considerable sampling error. This proportion seems to rise with age whereas the percentage of all children who were uninsured and Medicaid-eligible for all 12 months remains steady or even falls.13

Periods of uninsurance without Medicaid eligibility occurred with a frequency between that of Medicaid-eligible uninsurance and all uninsurance (Table 26). Because uninsured children below age 10 were nearly twice as likely to be eligible for Medicaid as children 10 and older, the proportion of children who were ever uninsured and not eligible for Medicaid during the year rises more sharply with age than the percentage who were simply ever uninsured. From 6 percent among infants the percentage ever uninsured and not Medicaid-eligible rises to 24 percent among 18-year-olds. Mean durations in this state rose by two to three months over the range of ages, with an average duration of 6.2 months, while the percentage of those remaining in the state for 12 months grew from the low single digits to over 30 percent, with an average of 20 percent. Among all children, the percentage who were uninsured without Medicaid eligibility for the entire year rose from .3 percent among infants to nearly 8 percent among 18-year-olds.

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