Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 3. Duration of New Spells of Medicaid-Eligible Uninsurance

05/12/1999

As with all spells of uninsurance, the duration of spells of Medicaid-eligible uninsurance shows similarly weak relationships to the demographic and socioeconomic characteristics of uninsured children. Part of the explanation is the very high proportion of spells that are completed in 4 months or less: 75 percent (Table 18). This leaves little room for significant variation across population subgroups.

Only infants show a pattern that differs to any degree from that of other age groups. Infants are somewhat less likely to have spells of one 1 to 4 months than the other age groups--65 percent versus about 76 percent--but they are no more likely than other groups to have very long spells. Non-Hispanic white children have both the highest frequency of very short spells, at 81 percent, and the lowest frequency of very long spells, at just under 5 percent. Other differences by race and ethnicity are negligible. Children in two-parent or father-only families also have the highest frequency of very short spells, at 77 to 79 percent, and the lowest frequency of very long spells, at 5 percent. The corresponding percentages for children in mother-only families are 70 percent and 9 percent, respectively. Children from no parent families compare at 70 percent and 10 percent.

TABLE 18: COMPLETED DURATION OF NEW SPELLS OF MEDICAID-ELIGIBLE UNINSURANCE IN FY93, BY DEMOGRAPHIC CHARACTERISTICS AT START OF SPELL
Demographic Characteristic Completed Duration in Months Total
1 to 4 5 to 8 9 to 12 13+
All Children 74.8 12.5 6.4 6.2 100
Age of Child          
    Infant (0) 65.5 18.8 9.1 6.6 100
    1 to 5 74.7 12.3 5.7 7.3 100
    6 to 8 73.1 17.1 7.2 2.6 100
    9 to 10 76.8 9.7 7.2 6.3 100
    11 to 15 79.1 8.1 5.3 7.5 100
    16 to 18 74.9 12 7.7 5.4 100
Race/Ethnicity of Child          
    White Non-Hispanic 80.8 10.1 4.4 4.7 100
    Black Non-Hispanic 66.3 18.5 6.9 8.3 100
    Hispanic 70 12.1 10.6 7.2 100
    Other 69.1 18.8 3.3 8.8 100
Family Composition          
    Both Parents Present 77 11.2 7 4.9 100
    Mother Only Present 69.7 15.9 5.3 9 100
    Father Only Present 78.7 7.6 8.5 5.2 100
    No Parent Present 69.8 17.8 2.2 10.2 100
Metropolitan Residence          
    Metro 72.4 13 8 6.7 100
    Non-Metro 81.9 10.7 2.6 4.7 100
    Not Applicable 54 29.2 5.9 10.9 100
Region          
    New England 74.6 13.8 0 11.7 100
    Middle Atlantic 61.2 19.8 4.4 14.7 100
    East North Central 72 7.9 12 8.2 100
    West North Central 80.9 19.1 0 0 100
    South Atlantic 77.7 15.5 4.2 2.6 100
    East South Central 69.4 9.6 8.4 12.6 100
    West South Central 76.4 13.9 4.4 5.4 100
    Mountain 67.6 8.5 14.8 9.1 100
    Pacific 80 9 7.5 3.4 100
SOURCE: Survey of Income and Program Participation, 1992 Panel.

There is a 10 percentage point difference between metropolitan and non-metropolitan children in the proportion of spells completed in 1 to 4 months. The children to whom the metropolitan/non-metropolitan classification is not applicable differ from the other two groups in the proportion of spells that are completed in 1 to 4 versus 5 to 8 months and in the proportion running 13 months or longer, but the uncertainty about who this group represents makes it unclear what this is telling us.

Because the number of children experiencing spells of Medicaid-eligible uninsurance is much smaller than the number who experience any spells of uninsurance, sampling error makes a greater contribution to the differentials in these tables than the earlier tables, and this is nowhere more

evident than in the regional differences. The West North Central and Pacific regions have the highest percentages of very short spells, at 80 to 81 percent, and among the lowest frequencies of very short spells, at 0 to 3 percent. The South Atlantic and West South Central regions are similar. Unlike all of the earlier tables, the New England region shows nothing distinctive in its patterns. In general, the regional patterns in Table 18 deviate so much from what we have seen earlier that we should be cautious in attaching much credence to them.

Table 19 reports shares of spells within each duration group by demographic characteristics. In general, we see little variation across the columns. Non-Hispanic white children account for 56 percent of the shortest spells compared to 39 percent of the longest spells while non-Hispanic black children represent 26 percent of the longest spells compared to 17 percent of the shortest spells. Similarly, children in two-parent families account for 66 percent of the shortest durations compared to 51 percent of the longest durations while children from mother-only families account for 26 percent of the shortest durations but 40 percent of the longest. A comparison with Table 8 indicates that these findings are consistent with the relative frequency of Medicaid eligibility among uninsured children by race and ethnicity and family composition although they appear to run counter to the

TABLE 19: DISTRIBUTION OF DEMOGRAPHIC CHARACTERISTICS BY COMPLETED DURATION OF NEW SPELLS OF MEDICAID-ELIGIBLE UNINSURANCE, FY93
  Completed Duration in Months
Demographic Characteristic 1 to 4 5 to 8 9 to 12 13+
Age of Child 100 100 100 100
    Infant (0) 5.7 9.8 9.2 6.9
    1 to 5 38.8 38.2 34.3 45.8
    6 to 8 17.3 24.1 19.9 7.5
    9 to 10 10.1 7.6 11 9.9
    11 to 15 19.2 11.7 14.9 22.1
    16 to 18 9 8.6 10.7 7.8
Race/Ethnicity of Child 100 100 100 100
    White Non-Hispanic 55.5 41.3 35 39
    Black Non-Hispanic 16.8 27.9 20.4 25.5
    Hispanic 24.1 24.8 42.6 29.9
    Other 3.7 5.9 2 5.7
Family Composition 100 100 100 100
    Both Parents Present 66.5 57.6 70.1 50.7
    Mother Only Present 25.7 35.1 22.7 40.2
    Father Only Present 4.8 2.8 6.1 3.8
    No Parent Present 3 4.5 1.1 5.3
Metropolitan Residence 100 100 100 100
    Metro 68.2 72.9 87.3 76.2
    Non-Metro 30.8 24.1 11.5 21.5
    Not Applicable 0.9 3.1 1.2 2.3
Region 100 100 100 100
    New England 2.6 2.9 0 5
    Middle Atlantic 8 15.5 6.7 23.3
    East North Central 13.8 9 26.7 19
    West North Central 6.8 9.5 0 0
    South Atlantic 18.3 21.7 11.6 7.3
    East South Central 7 5.8 9.9 15.4
    West South Central 14.6 15.9 9.7 12.4
    Mountain 2.6 1.9 6.5 4.2
    Pacific 26.3 17.7 28.9 13.5
SOURCE: Survey of Income and Program Participation, 1992 Panel.

differentials that we find in Medicaid participation (see Table 3). Clearly, a high participation rate in Medicaid does not imply that children leave spells of Medicaid-eligible uninsurance relatively quickly.

Metropolitan area children account for a bigger share of long spells than short spells at 76 percent versus 68 percent while non-metropolitan area children account for 31 percent of the shortest spells and 22 percent of the longest. Regional differences again show the effects of particularly large sampling error. Every region displays fairly wide variation in its shares of spells of different durations, but these differences do not yield a clear pattern.

Differences in the duration of spells of Medicaid-eligible uninsurance by socioeconomic characteristics are much weaker than the differences we reported in the duration of all spells of uninsurance (compare Table 20 with Table 16). There are negligible differences across the first three poverty classes, where sample sizes are largest, and the two highest poverty classes are not substantially different, given their very small numbers.10 Children with working parents, whether full time or part time, tend to have a greater frequency of short spells than children with no working parents or no parents present and a somewhat lower frequency of very long spells. Differences in spell duration by parents' education are very inconsistent, suggesting that what differences we do see are strongly affected by sampling error. Children whose parents attended graduate school clearly have the shortest spells, with 82 percent being 1 to 4 months in length and only 1 percent exceeding 8 months. Children whose parents completed less than 7 years of schooling have the longest spells, with 60 percent being 1 to 4 months and 23 percent 9 months or longer. But children whose parents completed college (and went no farther) look more like children whose parents completed only 7 to 11 years of schooling than they resemble children whose parents attended but did not complete college or completed college and went on to graduate school.

TABLE 20: COMPLETED DURATION OF NEW SPELLS OF MEDICAID-ELIGIBLE UNINSURANCE IN FY93, BY SOCIOECONOMIC CHARACTERISTICS AT START OF SPELL
  Completed Duration in Months  
Socioeconomic Characteristic 1 to 4 5 to 8 9 to 12 13+ Total
Poverty Level          
    Less than 50% FPL 74.9 15.5 4.6 5.1 100
    50% to < 100% FPL 74.7 12.7 7.1 5.5 100
    100% to < 200% FPL 75.5 10.4 7.1 7 100
    200% to < 300% FPL 67.8 18.4 3 10.7 100
    300% FPL or Greater 75.8 3 11.3 9.9 100
Parents' Employment          
    1 or More Full Time 78.4 11.6 4.4 5.7 100
    Part Time Only 74.9 11.4 9.5 4.3 100
    No Working Parent 66.6 14.9 10.4 8.1 100
    No Parent Present 69.8 17.8 2.2 10.2 100
Parents' Education          
    No Parent Present 69.8 17.8 2.2 10.2 100
    6 Years or Less 59.9 16.9 19.4 3.8 100
    7 to 11 Years 72.8 10.7 6.7 9.8 100
    12 Years 74.7 13.7 6.1 5.6 100
    Attended College 81.8 11 2.5 4.8 100
    4-Year College Degree 72.9 5.6 14.6 6.9 100
    Graduate Work 81.9 16.8 1.2 0 100
SOURCE: Survey of Income and Program Participation, 1992 Panel.

There are somewhat greater differences in the shares of spells of different durations by socioeconomic characteristics (Table 21) than by demographic characteristics (Table 19). Children in families below 50 percent of poverty account for smaller shares of spells 9 months or longer than they do of spells completed in 8 months or less, but patterns at higher family income levels are less clear. Children in families above 100 percent of poverty represent somewhat larger shares of the spells lasting 9 months or longer than they do of spells ending in 8 months or less. Children without working parents account for larger shares of spells 9 months or longer than they do of shorter spells while children with at least one parent working full time show the reverse pattern, but even here sampling error is evident in the volatility of the shares. Finally, children whose parents completed 7 to 11 years of schooling account for 33 percent of the longest durations compared to no more than 22 percent of any class of shorter durations whereas children whose parents attended but did not complete college represent 14 percent of the longest durations compared to 20 percent of the shortest.

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