Analysis of Children's Health Insurance Patterns: Findings from the SIPP. B. Measuring Children’s Health Insurance Coverage

05/12/1999

The SIPP ascertains health insurance coverage by means of a series of questions that ask about specific types of coverage or about coverage in general. These questions are placed relatively early in the SIPP interview, when respondents are likely to be more attentive. By contrast, the health insurance questions in the March supplement to the Current Population Survey (CPS) are placed near the end of the interview.

The applicable questions are reproduced below.

20a.(If ... is 65 years of age or older or ... has a work disability) Medicare is a health insurance program for disabled persons and persons 65 or older. People covered by Medicare have a card that looks like this (SHOW FLASHCARD L). Was ... covered by Medicare?

23a.(If ... is 18 or older or the designated parent or guardian of children under 18 years old who live in the household) During the 4-month period, was ... covered by (use local name for Medicaid) or another public assistance program that pays for medical care?

b.May I see ...’s (use local name for Medicaid) card to record the claim number?

23c.(If ... is the designated parent or guardian of children under 18 years old who live in this household) Were any of ...’s children (under 18) covered by (use local name for Medicaid)?

d.(If yes) Which children were covered?

23e.(If 23a or 23c is marked yes) Was (.../(and)...’s children) covered during the entire 4- month period?

f.(If no) In which months was (.../(and)...’s children) covered?

24a.Was ... covered by a health insurance plan at any time during the past 4 months? (Include CHAMPUS, CHAMPVA, and military coverage. Exclude Medicaid, Medicare, and plans paying benefits only for accidents or specific diseases.) (If no, skip to 24k.)

b.Was ... covered by a health insurance plan during the entire 4-month period?

c.(If no) In which months was ... covered?

d.Was ...’s health insurance coverage from a plan in ...’s own name (primary policy holder) or was ... covered as a family member on someone else’s plan? (If own name, skip to 24f.)

24e.Whose plan covered ...? (Skip to 24k.)

f.Was ...’s policy obtained through ...’s current employer or union, through a former employer, through the CHAMPUS or CHAMPVA programs, or in some other way?

g.(If current employer or union or former employer) Did ...’s employer or union (former employer) pay all, part or none of the premium (cost) of this plan?

h.Was ...’s plan an individual plan or a family plan? (If individual, skip to 24k.)

i.Other than ..., which persons in this household were covered by ...’s plan? (Include children as well as adults.)

j.Did ...’s plan cover anyone who did not live in this household during the past 4 months? (If yes) Who did the plan cover?

24k.(If ... is the designated parent or guardian of children under 15 years old who live in the household) Were all of ...’s children under 15 years old covered by a health insurance plan? (Include CHAMPUS, CHAMPVA, and military plans.) (Exclude Medicare, Medicaid, and plans paying benefits only for accidents or specific diseases.)

l.(If no) Which children were covered by a health insurance plan?

24m.(If 24k is yes or one or more children is listed in response to 24l) Were any of these children covered by the plan of someone who did not live in the household during the past 4 months? (If yes) Which children?

These questions were asked of all household members 15 and older, with some additional qualifying restrictions as noted. Coverage of children under 15 was ascertained from those questions that asked explicitly about the coverage of respondents’ children or other household members--that is, question 23d for Medicaid and questions 24i, 24k and 24l for other types of coverage. Note that question 24i could be the source of reported coverage for adults as well as children.

From the fields provided on the SIPP files we assigned each sample person to one of 13 categories of insurance coverage in each calendar month from January 1992 through September 1994. In making assignments to children, and presumably many spouses as well, we often had to refer to the record of a parent or other adult in the household to determine the source of coverage. This was not true for Medicaid or Medicare, but it was true for every other source. The SIPP data file identifies the household member providing the coverage when the plan is in another member’s name, and we used this information to link to that person’s record and access variables describing the source of coverage. When the coverage was provided by someone outside of the household, no source could be identified. We relegated to a separate category those children whose only coverage was provided by someone outside the household. Similarly, if a child’s coverage was reported under question 24k or 24l, then no information on the source was available.(4) We assigned such children to a residual coverage category indicating that we had no information on the type of coverage.(5)

Finally, a person could have been reported as covered by more than one type of plan during a given month. Clearly, Medicaid could be reported in combination with any other type of plan. Married persons could be reported as having their own employer-sponsored or other plan and being covered by their spouse’s plan. Similarly, children could be reported as covered by both parents’ plans, although the Census Bureau’s coding of the responses does not seem to allow for recording coverage under more than one parent’s plan (there is only one variable pointing to another household member as the source of coverage). Where two or more sources of coverage are reported, they may have been overlapping, or one source may have terminated while another began. Rather than trying to capture and display multiple sources of coverage, we elected to assign a single source of coverage to each person, following a priority scheme. In view of the focus of our research, we assigned Medicaid the highest priority. That is, any child who was reported to be covered by Medicaid, regardless of whatever other coverage may have been reported in that month, was coded as a Medicaid enrollee.(6) Priority was accorded to other coverages in the following order:

  • Medicare
  • Other coverage held in one’s one name
  • Other coverage held in another household member’s name
  • Coverage provided by someone outside the household
  • Generic other coverage not associated with another household member
  • Uninsured

Beyond Medicaid, then, this scheme gives priority to assigning the type of coverage for which we have the most information.

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