Analysis of Children's Health Insurance Patterns: Findings from the SIPP. b. Distribution of Insurance Coverage

05/12/1999

Table 3 presents for each of the five demographic characteristics the distribution of insurance coverage by subgroup.

The inverse relationship between age and Medicaid coverage and the direct relationship between age and uninsurance are striking, but it is important to keep in mind the generally antecedent role of employer-sponsored and other insurance. The older the child, the more likely that the child is covered by either employer-sponsored or other insurance (generally privately purchased or public insurance other than Medicaid). The 71 percent of children 16 to 18 who are covered by either of these sources contrasts with 64 percent of infants and 65 percent of children 1 to 5. Among those children who might otherwise be uninsured, Medicaid is much more likely to be utilized by younger children (who are more likely to be eligible) than older children. At the extremes, Medicaid covers nearly three-quarters of the infants who lack other coverage but less than half of the 16- to 18-year- olds who, similarly, have no other coverage. The percentage of all children covered by Medicaid in each age group varies from 12 percent among children 16 to 18 to a maximum of 26 percent among infants, with the proportion rising monotonically as age decreases. The frequency of uninsurance, conversely, rises from 9 percent among infants to 16 percent among children 16 to 18.

TABLE 3: DISTRIBUTION OF CHILDREN'S INSURANCE COVERAGE BY DEMOGRAPHIC CHARACTERISTICS: SEPTEMBER 1994
Demographic Characteristic Employer- Sponsored Medicaid Other Uninsured Total
All Children 64.1 19 4.2 12.7 100
Age of Child          
    Infant (0) 61.2 26.3 3.2 9.3 100
    1 to 5 60.6 25.4 3.4 10.5 100
    6 to 8 64.1 20.3 3.7 11.9 100
    9 to 10 63.3 18 4.9 13.8 100
    11 to 15 67.4 14.5 4.5 13.6 100
    16 to 18 66.1 12.4 5.2 16.3 100
Race/Ethnicity of Child          
    White Non-Hispanic 74.1 10.7 5.2 10 100
    Black Non-Hispanic 41.8 44.2 1.4 12.5 100
    Hispanic 38.8 33.6 1.4 26.3 100
    Other 59.2 18.3 5.6 16.8 100
Family Composition          
    Both Parents Present 74.9 8.5 5 11.5 100
    Mother Only Present 35.8 47.6 1.8 14.7 100
    Father Only Present 55 21.5 2.3 21.3 100
    No Parent Present 26.8 47.4 2.8 23 100
Metropolitan Residence          
    Metro 65.5 18.5 3.7 12.2 100
    Non-Metro 60.3 19.8 5.6 14.3 100
    Not Applicable 58 26.4 0.8 14.7 100
Region          
    New England 76.1 13.6 3.2 7.1 100
    Middle Atlantic 66.2 21.6 2.9 9.2 100
    East North Central 67.5 19.5 2.4 10.6 100
    West North Central 70.2 14 7.9 7.9 100
    South Atlantic 66.1 17.9 3.5 12.5 100
    East South Central 58.1 23.9 2.1 16 100
    West South Central 58.5 14.8 5.1 21.5 100
    Mountain 65.6 17.9 4.9 11.7 100
    Pacific 56 22.3 6.1 15.6 100
SOURCE: Survey of Income and Program Participation, 1992 Panel.

There are very strong differentials by race and ethnicity (Hispanic origin). Non-Hispanic whites have the highest rate of coverage by employer-sponsored plans at 74 percent and the lowest rates of Medicaid coverage (about 11 percent) and uninsurance (10 percent). Non-Hispanic blacks have the highest rate of Medicaid coverage at 44 percent or four times the rate among whites. Blacks also have the second lowest coverage by employer-sponsored plans at 42 percent, but the rate of uninsurance among blacks is only 2.5 percentage points above that of whites. Hispanics report the highest rate of uninsurance by far at 26 percent, with the lowest rate of coverage by employer-sponsored plans, but 34 percent report Medicaid coverage--a rate that is three times that of non-Hispanic whites. In all coverage groups but other insurance the other races category falls between non-Hispanic whites and Hispanics--generally closer to whites. While coverage by other than employer-sponsored plans or Medicaid is quite low at 4 percent nationally, non-Hispanic whites and other races report much higher coverage--between 5 and 6 percent--than do Hispanics and non-Hispanic blacks.

Differentials by family composition are as great as those by race and ethnicity. Children with both parents present have the highest rates of employer-sponsored and other coverage at 75 percent and 5.0 percent, respectively, and the lowest rates of Medicaid coverage and uninsurance: 8.5 percent and about 12 percent. At the opposite end, children with no parent present have the lowest rate of employer coverage at 27 percent--barely one-third the rate for children with both parents present--and the highest rate of uninsurance at 23 percent or double that of children with both parents present. Children with no parent present share the highest rate of Medicaid coverage with children in mother- only families, at 47 to 48 percent. Children in mother-only families have a much lower rate of uninsurance than children in father-only or no-parent families. Compared to children with no parent present, children in mother-only families have a higher rate of employer-sponsored coverage. Compared to children in father-only families, children in mother-only families are covered by Medicaid at a rate that more than compensates for their lower employer-sponsored coverage.

Differences by metropolitan residence are marginal at best. Children in non-metropolitan areas have a higher rate of uninsurance by two percentage points. Their lower rate of employer-sponsored coverage is partially offset by marginally higher coverage rates for Medicaid and other insurance. Children who could not be classified as metropolitan or not are too few in number for their coverage rates to provide meaningful information, but their rates of employer-sponsored coverage and uninsurance are strikingly similar to those of non-metropolitan children.

Finally, regional differences in rates of uninsurance are quite substantial. New England has the lowest rate at 7.1 percent while the West South Central region has the highest rate at 22 percent or three times the rate observed in New England. In general, rates of uninsurance are highest in the South and the West. Much of the latter, we suspect, can be attributed to the high proportion Hispanic in the Western states. The role of Medicaid in these regional differences in rates of uninsurance is ambiguous--no doubt because higher than average rates of Medicaid participation can reflect either or both the prevalence of poverty and broader eligibility criteria. Employer-sponsored coverage varies over a range of 20 percentage points, with New England having the highest rate of coverage and the Pacific states having the lowest, followed closely by the East and West South Central states.

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