Analysis of Children's Health Insurance Patterns: Findings from the SIPP. 4. Duration of Active Spells of Uninsurance

05/12/1999

Earlier in this section we examined demographic and socioeconomic differentials in the lengths of completed spells of uninsurance. Spells that are active at a point in time have a different distribution--both currently and, especially, when completed--than do spells that started during a year. Furthermore, because active spells are generally not complete (some will end in that month, but most will continue), the relationships beween their duration and various characteristics of the uninsured differ from what we would observe with completed spells. More specifically, the shorter the active duration, the greater the proportion of these spells that will end up with longer completed durations. In terms of their characteristics, children who are in short active spells will look much more like children with completed spells of all durations than they do like children with completed spells of short duration. We would be much less interested in the characteristics of uninsured children by how long they have been uninsured were it not for the fact that state CHIP plans frequently limit coverage to children who have already accumulated some specified number of months of uninsurance. Table 22 compares the distributions of active spell lengths and completed spells by three characteristics: the child's age, family poverty level, and parents' employment.

TABLE 21: DISTRIBUTION OF SOCIOECONOMIC CHARACTERISTICS BY COMPLETED DURATION OF NEW SPELLS OF MEDICAID-ELIGIBLE UNINSURANCE, FY93
Socioeconomic Characteristic Completed Duration in Months
1 to 4 5 to 8 9 to 12 13+
Poverty Level 100 100 100 100
    Less than 50% FPL 25.4 31.3 18.1 20.7
    50% to < 100% FPL 34.5 34.9 37.9 30.9
    100% to < 200% FPL 34.8 28.6 38.1 39
    200% to < 300% FPL 2.8 4.5 1.4 5.3
    300% FPL or Greater 2.5 0.6 4.4 4
Parents' Employment 100 100 100 100
    1 or More Full Time 62.6 55.2 40.8 54.6
    Part Time Only 13.2 12 19.4 9.1
    No Working Parent 21.2 28.3 38.7 31
    No Parent Present 3 4.5 1.1 5.3
Parents' Education 100 100 100 100
    No Parent Present 3 4.5 1.1 5.3
    6 Years or Less 4.5 7.5 16.8 3.5
    7 to 11 Years 20.3 17.7 21.7 33.1
    12 Years 41.7 45.6 39.5 37.9
    Attended College 19.6 15.7 6.9 13.8
    4-Year College Degree 5.7 2.6 13.2 6.5
    Graduate Work 5.3 6.5 0.9 0
SOURCE: Survey of Income and Program Participation, 1992 Panel.

Active spells are limited to those of children who were uninsured in September 1993 while the completed spells represent all spells that were started in FY93.

The active spells include a higher proportion of very long spells than do the completed spells; 46 percent of the children uninsured in September 1993 had already been uninsured for 13 months or more whereas only 20 percent of all the spells that started in FY93 (which may include multiple spells by the same individuals) extended beyond 12 months.

Infants have much shorter active spells than completed spells because spell lengths are bounded by their very limited life spans. We see no infants with spells exceeding 12 months, of course, because no infant, by definition, has been alive for more than 12 months. By contrast, there is no limit to the completed spell length of children who were infants when their spells began, and infants have nearly the same proportion of completed new spells exceeding 12 months as older children: 17 percent compared to 18 to 22 pecent for older children). The proportion of older children whose active spells exceed 12 months rises 20 percentage points--from 36 percent to 56 percent--between ages 1 to 5 and ages 11 to 15 but then drops slightly, to 49 percent, in the next age group. The proportion of new spells exceeding 12 months in length shows no increase with age after infancy, however. It is not clear why we should see an age difference in the current duration of active spells when there is no age difference in the completed durations of new spells. Active spells are in some sense sampled from new spells but with a probability proportional to (completed) length. It must be that the age differences that we see among active spells are due to age differences that do not appear in new spells until durations well beyond 13 months.

TABLE 22: CURRENT DURATION OF ACTIVE SPELLS COMPARED TO COMPLETED DURATION OF NEW SPELLS BY SELECTED CHARACTERISTICS: SPELLS ACTIVE IN SEPTEMBER 1993 AND NEW SPELLS BEGINNING IN FY93
Characteristic Current Durationof Active Spells in Months Completed Duration of New Spells in Months
1 to 4 5 to 8 9 to 12 13+ Total 1 to 4 5 to 8 9 to 12 13+ Total
All Children 34.6 12.1 7.5 45.8 100 54 16.9 9 20.1 100
Age of Child                    
    Infant (0) 81.3 12.5 6.2 0 100 58.9 15.5 8.2 17.4 100
    1 to 5 37.8 13.9 12.1 36.3 100 56.7 14.2 9.3 19.8 100
    6 to 10 36.4 12 6.2 45.4 100 51.4 18.8 8 21.7 100
    11 to 15 28.4 10.3 5.3 56 100 55.1 16.3 10.4 18.2 100
    16 to 18 30.8 12.6 7.5 49.2 100 49.8 20.2 8.1 21.8 100
Poverty Level                    
    Less than 50% FPL 37.3 10.2 7.6 44.8 100 62.8 15.5 8.1 13.7 100
    50% to < 100% FPL 39 11 6.3 43.7 100 55.3 17 8.6 19.1 100
    100% to < 200% FPL 31.2 11.3 7.6 49.8 100 50.8 17.8 8.6 22.8 100
    200% to < 300% FPL 31.8 14.5 8.7 45 100 51.2 13.6 11.4 23.8 100
    300% FPL or Greater 40.7 16.4 7.8 35.1 100 53 19.7 9.5 17.8 100
Parents' Employment                    
    1 or More Full Time 33.6 11.9 7.6 46.9 100 53.5 17.2 8.5 20.8 100
    Part Time Only 35.7 13 6 45.3 100 49.8 20.2 13.1 16.8 100
    No Working Parent 39.6 11 5.8 43.6 100 56.3 14.5 10.5 18.7 100
    No Parent Present 34.2 14.1 15.1 36.6 100 60.3 15.6 2.6 21.5 100

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

NOTE: For active spells, characteristics refer to September 1993. For new spells, characteristics refer to the start of the spell.

There are differences in the durations of both completed spells and active spells by poverty level, but the differences among active spells are weaker. The proportion of children with completed spells of 1 to 4 months declines from 63 percent to 51 percent over the first three income classes while the change among active spells is only 6 percentage points. Similarly, the proportion of new spells exceeding 12 months in length rises from 14 percent to 23 percent over the first three income classes whereas the increase among active spells is only 5 percentage points. Both distributions show an upturn in the relative frequency of short spells as income rises to more than 300 percent of poverty.

Parents' employment shows little relationship to the duration of completed spells. Children with no parent present have a somewhat higher frequency of short spells than other children, but there are no other consistent differences. Among children with active spells, those with no parents present have fewer spells exceeding 12 months than other children but comparable numbers of spells exceeding 8 months. Children with no working parents are somewhat more likely to have been uninsured for less than 5 months than children with working parents, but again the differences are modest.

Differences in the shares of active spells by demographic and socioeconomic groups are of interest because of what they tell us about the composition of children who may be eligible for state CHIP coverage. As we have pointed out, infants by definition cannot be uninsured for more than 12 months. States that would like to cover infants but choose to limit their coverage to children who have been uninsured for 12 months or more or even 6 months or more will have to consider defining eligibility among infants on some basis other than the length of their own spells of uninsurance, or infants will receive disproportionately little coverage. In Table 23 we see that while infants account for 7 percent of the spells of uninsurance that started 1 to 4 months earlier, they account for only 3 percent of the spells that started 5 to 8 months earlier and closer to 2 percent of the spells that started 9 to 12 months earlier. Shares of active spells that started more than 12 month earlier rise with age.

Children 1 to 5 account for 18 percent of such spells while children 11 to 15 account for 35 percent. There is little difference, however, in the age group shares of spells lasting 9 months or longer.

Both active spells and completed spells show the share of children in families between 100 and 200 percent of poverty rising with duration. This group accounts for 36 percent of the active spells that started 1 to 4 months earlier compared to 44 percent of the spells that started more than 12 months earlier. Completed spells show the share of children in this group rising from 34 percent to 41 percent. Other poverty classes show less variation in their shares of children with different durations of uninsurance.

Shares of the uninsured by parents' employment show minimal variation by parents' employment. For active spells, no employment group's share varies by more than 4 percentage points. There is somewhat greater variation among completed spells, but no group shows consistent growth or decline in its share of all spells as duration increases.

On the whole, then, spells active at a point in time show no greater evidence of demographic or socioeconomic differentials in duration than new spells that started over the course of a year.

TABLE 23: DISTRIBUTION OF SELECTED CHARACTERISTICS BY SPELL LENGTH: SPELLS ACTIVE IN SEPTEMBER 1993 AND NEW SPELLS BEGINNING IN FY93
Characteristic Currenthurationof Active Spells Completed Duration of New SpSpells
1 to 4 5 to 8 9 to 12 13+ 1 to 4 5 to 8 9 to 12 13+
Age of Child 100 100 100 100 100 100 100 100
    Infant (0) 6.8 3 2.4 0 6.9 5.8 5.8 5.5
    1 to 5 24.9 26.3 36.7 18.1 29.8 23.7 29.4 28.1
    6 to 10 27.3 25.9 21.3 25.7 23.1 27 21.7 26.2
    11 to 15 23.8 24.7 20.4 35.4 24.9 23.5 28.1 22.1
    16 to 18 17.2 20.1 19.2 20.8 15.4 19.9 15 18.1
Poverty Level 100 100 100 100 100 100 100 100
    Less than 50% FPL 13.6 10.7 12.7 12.3 17.8 14 13.8 10.4
    50% to < 100% FPL 25 20.2 18.6 21.1 24.5 24 22.8 22.7
    100% to < 200% FPL 36.5 38 41 44 34.3 38.3 34.9 41.4
    200% to < 300% FPL 15.1 19.7 18.9 16.1 12.2 10.3 16.3 15.3
    300% FPL or Greater 9.9 11.4 8.8 6.5 11.3 13.4 12.2 10.2
Parents' Employment 100 100 100 100 100 100 100 100
    1 or More Full Time 67.3 68.4 70.6 70.9 65.8 67.6 62.5 68.9
    Part Time Only 15.7 16.3 12.1 15 9.1 11.8 14.5 8.3
    No Working Parent 12.8 10.2 8.7 10.6 19.2 15.8 21.5 17.1
    No Parent Present 4.3 5 8.7 3.4 5.9 4.9 1.5 5.6

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

NOTE: Active spell characteristics refer to September 1993. New spell characteristics refer to the start of the spell

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