Analysis of Children's Health Insurance Patterns: Findings from the SIPP. C. Estimates of Health Insurance Coverage

05/12/1999

Table 2 reports estimates of the health insurance coverage of children under 19 in each of the first three waves of the 1992 SIPP panel. These results are based on the full panel sample--that is, sample members who were present for the duration of the panel or until such time as they left the SIPP universe. Results are presented for the one month that was common to the reference periods of all four rotation groups in each interview wave--that is, January 1992 for wave 1, May 1992 for wave 2, and September 1992 for wave 3. Presenting Table 2 allows us to introduce the 13 categories of health insurance coverage that we identified with the SIPP variables and to show what change in the distribution of coverage may have occurred between the beginning of the 1992 and the eve of FY93, which along with FY94 is the focal period for the rest of this report.

The upper panel of Table 2 presents estimates of the number of children in each of the 13 coverage categories while the lower panel gives the percentage distribution for all children in each year. Given that the number of children represented by the panel declines over time while the total population of children rises, the percentage distributions provide greater comparability over time and may apply nearly as well to the full population as to the population that the panel actually represents in each month.

Source of Coverage   Wave 1
Jan-92
Wave 2
May-92
Wave 3
Sep-92
TABLE 2: ESTIMATES OF HEALTH INSURANCE COVERAGE OF CHILDREN UNDER 19: FIRST THREE WAVES OF 1992 SIPP PANEL
  TOTAL 72,103,000 71,566,000 71,432,000
1 Medicaid 11,618,000 12,231,000 12,390,000
2 Medicare 0 0 0
Current Employer        
3 Paying All or Part of Cost 39,749,000 39,150,000 39,252,000
4 Paying None of Cost 1,435,000 1,140,000 1,261,000
Former Employer        
5 Paying All or Part 838,000 701,000 744,000
6 Paying None of Cost 329,000 255,000 242,000
7 CHAMPUS 546,000 491,000 452,000
8 CHAMPVA 40,000 33,000 89,000
9 Military 1,140,000 1,091,000 946,000
10 Other 3,120,000 3,128,000 2,938,000
11 Provided by Someone outside the Household 3,197,000 3,044,000 2,837,000
12 Details Unknown 181,000 695,000 483,000
13 Uninsured 9,910,000 9,605,000 9,800,000
  TOTAL 100 100 100
1 Medicaid 16.1 17.1 17.3
2 Medicare 0 0 0
Current Employer        
3 Paying All or Part of Cost 55.1 54.7 55
4 Paying None of Cost 2 1.6 1.8
Former Employer        
5 Paying All or Part 1.2 1 1
6 Paying None of Cost 0.5 0.4 0.3
7 CHAMPUS 0.8 0.7 0.6
8 CHAMPVA 0.1 0 0.1
9 Military 1.6 1.5 1.3
10 Other 4.3 4.4 4.1
         
11 Provided by someone outside the Household 4.4 4.3 4
12 Details Unknown 0.3 1 0.7
13 Uninsured 13.7 13.4 13.7
SOURCE: Survey of Income and Program Participation, 1992 Panel.

The first two sources of coverage, Medicaid and Medicare, require no explanation. Categories 3 through 6 refer to the current or former employer of a child’s parent or guardian, generally, although an older teen could have reported coverage by his or her own employer. Category 3, which accounts for 55 percent of children in each wave, refers to an employer- or union-sponsored plan with the employer or union paying all or part of the cost of the premiums. Category 4, which accounts for 2 percent or less of children, includes plans that the employer or union offers with no subsidization. Category 5 involves coverage that a former employer continues to subsidize while category 6, representing no more than half a percent of all children, is coverage associated with a former employer but with no (further) employer subsidy. Coverage obtained under COBRA would appear to fall in category 6, although the questions on which this category is based could easily lead COBRA participants to report their coverage elsewhere. Categories 7 through 9 refer to coverage provided by CHAMPUS, CHAMPVA, or the military. Category 10 refers to a source of coverage other than 1 through 9. This may include a state-only plan or coverage purchased in the private insurance market. Category 11 is coverage provided by someone living outside the child’s household--typically a divorced or absent parent. SIPP tells us nothing about the source of the coverage because the person in whose name the coverage is held is not interviewed, but we can infer that this coverage would be assigned to one of categories 3 through 10.

Category 12 consists of coverage that could not be classified under one of the preceding 11 categories. This category accounts for only .3 percent of all children in the first wave but then grows to 1 percent in the second wave and remains close to that level in wave 3. We suspected that most of the children classified under category 12 were placed in that category by their parents’ responses to question 24k. That is the children were reported as covered but were not identified with the plan of any adult in the household. If all of the children assigned to category 12 were allotted to the category for that reason, then we would expect to find that all of them were under 15 years of age, based on the final screen for question 24k. While disproportionate numbers of the children in category 12 were indeed under age 15, there remained enough who were over that limit to persuade us that some other explanation was operative. Because the health insurance variables on the SIPP file are not identified with specific questions, it is difficult to determine how a child could end up in category 12 other than by question 24k. We are left to infer that some of the information on children’s coverage must have been incomplete. For example, the Census Bureau may have coded the child as covered under another household member’s plan but either failed to identify or misidentified the household member responsible for the coverage. With further review of individual records it may be possible to resolve why these code 12 assignments were made, but it may not be possible to determine the correct coverage in each instance. Given the low frequency of this category, further investigation may have little merit.

The final category consists of children with no reported coverage. The relative frequency of this category remained at 13.7 percent between waves 1 and 3. During this same period, the proportion of children reporting Medicaid coverage rose from 16.1 percent to 17.3 percent. This rise was offset by a decline in other types of coverage sufficient to leave unchanged the proportion of children reported as uninsured.

Table 3 presents estimates of children’s health insurance coverage for selected months of FY93 and FY94. The first page provides estimates of numbers of children while the second page gives percentages of all children. Reported Medicaid coverage continues the rise observed in Table 2., growing to 19.0 percent of all children by September 1994. The percentage of children who are reported to be without health insurance declines by a full percentage point from September 1992 (in Table 2). The only other notable changes are a decline in the proportion reporting coverage under an employer plan to which the employer makes no contribution and a rise in the proportion of children who are reported to be insured but with no details provided. The former drops from 1.7 percent of all children to 1.2 percent while the latter increases from .8 percent to 1.1 percent.

TABLE 3: HEALTH INSURANCE COVERAGE OF CHILDREN UNDER 19: FY93 AND FY94, SELECTED MONTHS

Source of Coverage Number of Children
Oct-92 Dec-92 Jun-93 Sep-93 Dec-93 Jun-94 Sep-94
    TOTAL 71,549,000 71,323,000 71,111,000 70,868,000 70,795,000 70,197,000 69,935,000
Medicaid 12,614,000 12,829,000 13,328,000 13,369,000 13,233,000 13,264,000 13,253,000
Medicare 0 0 0 0 0 6,000 6,000
Current Employer              
    Paying All or Part of 39,174,000 39,174,000 38,872,000 38,350,000 38,925,000 37,929,000 38,039,000
    Paying None of Cost 1,228,000 1,074,000 1,107,000 968,000 844,000 991,000 837,000
Former Employer              

    Paying All or Part

781,000 639,000 727,000 685,000 790,000 1,031,000 506,000

    Paying None of Cost

276,000 253,000 214,000 246,000 275,000 272,000 309,000
CHAMPUS 539,000 705,000 631,000 567,000 502,000 573,000 465,000
CHAMPVA 89,000 51,000 63,000 79,000 55,000 39,000 88,000
Military 954,000 867,000 864,000 891,000 876,000 829,000 793,000
Other 3,007,000 3,050,000 2,823,000 2,831,000 2,727,000 2,911,000 2,907,000
Provided by Someone outside the Household 2,841,000 2,852,000 2,948,000 3,072,000 2,845,000 2,962,000 3,035,000
Details Unknown 559,000 522,000 587,000 539,000 702,000 670,000 786,000
Uninsured 9,489,000 9,141,000 8,947,000 9,271,000 9,021,000 8,719,000 8,911,000
Source of Coverage Percent of Total Children
Oct-92 Dec-92 Jun-93 Sep-93 Dec-93 Jun-94 Sep-94
    TOTAL 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Medicaid 17.6 18.0 18.7 18.9 18.7 18.9 19.0
Medicare 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Current Employer              
    Paying All or Part of 54.8 55.2 54.7 54.1 55.0 54.0 54.4
    Paying None of Cost 1.7 1.5 1.6 1.4 1.2 1.4 1.2
Former Employer              
    Paying All or Part 1.1 0.9 1.0 1.0 1.1 1.5 0.7
    Paying None of Cost 0.4 0.4 0.3 0.3 0.4 0.4 0.4
CHAMPUS 0.8 1.0 0.9 0.8 0.7 0.8 0.7
CHAMPVA 0.1 0.1 0.1 0.1 0.1 0.1 0.1
Military 1.3 1.2 1.2 1.3 1.2 1.2 1.1
Other 4.2 4.3 4.0 4.0 3.9 4.1 4.2
Provided by Someone outside the Household 4.0 4.0 4.1 4.3 4.0 4.2 4.3
Details Unknown 0.8 0.7 0.8 0.8 1.0 1.0 1.1
Uninsured 13.3 12.8 12.6 13.1 12.7 12.4 12.7
SOURCE: Survey of Income and Program Participation, 1992 Panel.

TABLE 4: CHILDREN UNDER 19 ENROLLED IN MEDICAID OR WITHOUT HEALTH INSURANCE AT END OF FISCAL YEAR OR EVER IN YEAR

Health Insurance by Period Number of Children Under 19 by Health Insurance Total Children Under 19 in Period Percent of Total Children Under 19
Medicaid      
    Enrolled in September 1993 13,369,000 70,868,000 18.9%
    Ever enrolled in FY93 17,800,000 74,691,000 23.8%
    Enrolled in September 1994 13,259,000 69,935,000 19.0%
    Ever enrolled in FY94 17,795,000 73,619,000 24.2%
    Ever enrolled in FY93 or FY94 21,043,000 77,697,000 27.1%
Uninsured      
    Uninsured in September 1993 9,271,000 70,868,000 13.1%
    Ever uninsured in FY93 16,089,000 74,691,000 21.5%
    Uninsured in September 1994 8,911,000 69,935,000 12.7%
    Ever uninsured in FY94 15,936,000 73,619,000 21.6%
    Ever uninsured in FY93 or FY94 21,074,000 77,697,000 27.1%
SOURCE: Survey of Income and Program Participation, 1992 Panel.

The upper panel of Table 4 compares enrollment in Medicaid at the end of each fiscal year to enrollment ever during the year. The lower panel makes the same comparison for uninsurance. For Medicaid the number ever enrolled in each fiscal year is one-third higher than the number enrolled at the end of the year. The number of children ever enrolled in Medicaid during the full two-year period is 58 percent higher than the number enrolled at the end of either year.(7) When compared to the one-year ever-enrollment, the two-year figure indicates very modest turnover from one year to the next, as the number of children ever enrolled over two years is less than one-fifth higher than the number ever enrolled in the first or second year.

Turnover among the uninsured is considerably higher than it is among Medicaid enrollees. The number of children ever uninsured during a fiscal year is about 75 percent higher than the number who are uninsured at the end of the year. The number ever uninsured during a two-year period is about 30 percent higher than the number ever uninsured in either year alone and about 130 percent higher than the number uninsured at the end of either year (or at any one time). For the two-year period, the percentage of children ever uninsured matches the fraction who were ever on Medicaid: 27.1 percent.

Table 5 presents estimates of the number and percentage of children who were without health insurance coverage by month for the calendar years 1992 through 1994. The percentage uninsured declines over the course of the first year but shows no trend after that. There is no evidence of seasonality in these numbers. We wanted to select two or three months to present statistics in this and the other technical appendices, and this table suggests that the choice is not particularly important. We elected to focus on the final two months of FY93 and FY94 in most of our cross- sectional tables, supplementing these with the first month of FY93 when appropriate. September 1993 happens to have a relatively high estimate of the uninsured, at 13.1 percent, compared to other months whereas September 1994, at 12.7 percent, is close to the average. It is important to keep in mind that the month-by-month results suggest that the difference between these two estimates does not reflect any trend.

TABLE 5: NUMBER AND PERCENTAGE OF CHILDREN UNDER 19 WHO WERE WITHOUT HEALTH INSURANCE COVERAGE, BY MONTH: 1992 THROUGH 1994

  Thousands of Children Percent of All Children
Month 1992 1993 1994 1992 1993 1994
January 9,910 9,126 9,009 13.7 12.8 12.7
February 9,950 9,144 9,098 13.8 12.9 12.9
March 9,790 8,974 9,050 13.6 12.6 12.8
April 9,493 9,133 8,998 13.3 12.8 12.8
May 9,605 9,137 9,025 13.4 12.8 12.8
June 9,610 8,947 8,719 13.4 12.6 12.4
July 9,639 9,222 8,694 13.5 13.0 12.4
August 9,713 9,134 8,745 13.6 12.9 12.5
September 9,800 9,271 8,911 13.7 13.1 12.7
October 9,489 9,080 9,017 13.3 12.8 12.9
November 9,238 8,920 8,966 12.9 12.6 12.9
December 9,141 9,021 8,749 12.8 12.7 12.6
SOURCE: Survey of Income and Program Participation, 1992 Panel.

Table 6 presents similar figures for reported Medicaid coverage. Here it is notable that the reported coverage rises from 16.1 percent in January 1992 to 18.7 percent in June 1993, then levels off (with modest swings). It is notable that the percentage point rise in reported Medicaid enrollment is nearly three times the decline in the percentage of children reported to be without health insurance coverage. This suggests that two-thirds of the enrollment increase is due to net movement from other sources of coverage rather than net movement out of the uninsured. We address this issue more directly in Technical Appendix B.

TABLE 6: NUMBER AND PERCENTAGE OF CHILDREN UNDER 19 WHO WERE REPORTED TO BE COVERED BY MEDICAID, BY MONTH: 1992 THROUGH 1994
  Thousands of Children Percent of All Children
Month 1992 1993 1994 1992 1993 1994
January 11,618 12,842 13,231 16.1 18 18.7
February 11,711 12,901 13,228 16.3 18.1 18.7
March 11,981 13,187 13,079 16.7 18.5 18.5
April 12,319 13,264 13,185 17.2 18.6 18.7
May 12,231 12,983 13,109 17.1 18.2 18.6
June 12,373 13,328 13,270 17.3 18.7 18.9
July 12,593 13,294 13,372 17.6 18.7 19.1
August 12,518 13,233 13,418 17.5 18.6 19.2
September 12,390 13,369 13,259 17.3 18.9 19.0
October 12,614 13,236 12,946 17.6 18.7 18.5
November 12,800 13,263 12,830 17.9 18.7 18.4
December 12,829 13,233 12,815 18.0 18.7 18.4
SOURCE: Survey of Income and Program Participation, 1992 Panel.

Table 7 provides information on sources of health insurance coverage in FY93, FY94, and the combined, two-year period. Figures for FY93 refer to coverage at any time during that year, and likewise for the FY94 figures. Figures for “FY93 and FY94" refer to the two year period. These estimates are based on our monthly measure of insurance coverage. While a child may in fact have been covered by more than one source in a month (or even at the same time), and SIPP can tell us about multiple sources of coverage during a month, we measured only one source per month, as explained above. Persons with multiple sources in this table, therefore, were covered by those sources at different times during the year (or two-year period for the last two columns of the table).

TABLE 7: PATTERNS OF HEALTH INSURANCE COVERAGE AMONG CHILDREN UNDER 19: FY93 AND FY94
  FY93 FY94 FY93 and FY94
Coverage Number Percent Number Percent Number Percent
    All Children under 19 74,691,000 100 73,619,000 100 77,697,000 100
Children with No Coverage during the Period 5,001,000 6.7 4,731,000 6.4 3,569,000 4.6
Children with Any Coverage during the Period 69,690,000 93.3 68,888,000 93.6 74,128,000 95.4
    Children with only one source of coverage 62,995,000 84.3 62,442,000 84.8 62,554,000 80.5
        Employer-sponsored 47,187,000 63.2 46,366,000 63 46,921,000 60.4
        Medicaid 13,918,000 18.6 14,124,000 19.2 14,075,000 18.1
        Other 1,889,000 2.5 1,952,000 2.7 1,558,000 2
    Children with multiple sources of coverage 6,695,000 9 6,446,000 8.8 11,574,000 14.9
        Employer-sponsored and Medicaid 3,550,000 4.8 3,373,000 4.6 6,242,000 8
        Employer-sponsored and other 2,813,000 3.8 2,775,000 3.8 4,606,000 5.9
        Medicaid and other 225,000 0.3 171,000 0.2 349,000 0.4
        All three sources 107,000 0.1 127,000 0.2 376,000 0.5

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

NOTE: All children under 19 includes children who were under 19 at the start of the indicated period as well as children born during the period.

We note that 6.7 percent of children reported no coverage of any kind in FY93, 6.4 percent reported no coverage in FY94, and 4.6 percent reported no coverage in either year. The remainder of the children in each of these periods reported coverage for at least part of the period. Between 84 and 85 percent reported only one source of coverage in each of the two years while 80.5 percent reported only one source over the two-year period. Within each of the two years, 63 percent reported only employer-provided coverage while about 19 percent reported only Medicaid coverage, with about 2.5 percent reporting coverage from another source. For the two-year period, these figures changed little: 60 percent reported only employer-provided insurance, 18 percent reported only Medicaid, and 2 percent reported only another source of coverage. We know from Table 3 that the proportion of children ever covered by Medicaid in the two-year period was higher than the proportion covered in either year alone. Table 7 shows that some of this increase is due to more children reporting Medicaid along with another source over the two-year period relative to one year. Specifically, 9 percent of children report Medicaid in combination with one or two other sources over the two-year period compared to 5 percent for either year alone. (The rest of the increase in Medicaid enrollment must be among children who were otherwise uninsured.)

In Table 8 we look at the incidence of uninsurance among children who reported any coverage during either or both fiscal years. Among children with any coverage, about 16 percent reported one or months of uninsurance in either fiscal year, and 24 percent reported a spell of uninsurance over the two-year period. The probability that a child with any coverage during a period was ever uninsured during that period varies substantially by type of coverage. Among children who were ever covered by Medicaid in either year, 28 percent were uninsured for part of the year. Among those who were ever covered by Medicaid over the two year period, the percentage who were ever uninsured during that period was 41 percent. For those with employer-provided insurance, the percentages uninsured were less than half these figures. Among those with other coverage, the proportions with any months of uninsurance were about midway between those for children ever covered by Medicaid versus employer-provided insurance.

Source of Coverage FY93 FY93 and FY94
TABLE 8: FREQUENCY OF UNINSURANCE AMONG CHILDREN WITH ANY COVERAGE, BY SOURCE: FY93 AND FY94
Children with any coverage 69,690,000 68,888,000 74,128,000
    Number ever uninsured 11,088,000 11,205,000 17,504,000
    Percent ever uninsured 15.9% 16.3% 23.6%
    Medicaid 17,800,000 17,795,000 21,043,000
        Number ever uninsured 5,077,000 5,002,000 8,569,000
        Percent ever uninsured 28.5% 28.1% 40.7%
    Employer-provided 53,657,000 52,641,000 58,146,000
        Number ever uninsured 6,750,000 6,852,000 11,627,000
        Percent ever uninsured 12.6% 13.0% 20.0%
    Other coverage 5,034,000 5,025,000 6,890,000
        Number ever uninsured 975,000 1,032,000 2,031,000
        Percent ever uninsured 19.4% 20.5% 29.5%
Children with one source of coverage 62,995,000 62,442,000 62,554,000
    Number ever uninsured 9,387,000 9,543,000 12,934,000
    Percent ever uninsured 14.9% 15.3% 20.7%
    Medicaid 13,918,000 14,124,000 14,075,000
        Number ever uninsured 3,808,000 3,825,000 5,163,000
        Percent ever uninsured 27.4% 27.1% 36.7%
    Employer-provided 47,187,000 46,366,000 46,921,000
        Number ever uninsured 5,150,000 5,300,000 7,276,000
        Percent ever uninsured 10.9% 11.4% 15.5%
    Other coverage 1,889,000 1,952,000 1,558,000
        Number ever uninsured 429,000 418,000 495,000
        Percent ever uninsured 22.7% 21.4% 31.8%
SOURCE: Survey of Income and Program Participation, 1992 Panel.

If we look at just those children who report one source of coverage, so that we can isolate the “impact” of the source of coverage, we find even more pronounced differences by type of coverage. While the incidence of uninsurance is generally lower among children with only one source versus two or more, children whose only source was Medicaid during a year had a 27 percent incidence of uninsurance while those whose only source was employer-provided insurance had only an 11 percent incidence of uninsurance. Among those with coverage from another source during a year, between 21 and 23 percent were uninsured for at least one month in the year.

These figures are particularly interesting in light of the policy focus on the CPS, which counts as uninsured only those persons who reported having had no coverage during the year and provides no estimate of persons who were uninsured for only part of the year. Estimates of the kind reported in Table 8 cannot be constructed with CPS data

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"AppendC_table13.PDF" (pdf, 3.89Kb)

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"AppendC_table14.PDF" (pdf, 4.6Kb)

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"AppendC_table15.PDF" (pdf, 4.21Kb)

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"AppendC_table16.PDF" (pdf, 3.86Kb)

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"AppendC_table17.PDF" (pdf, 3.88Kb)

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"AppendC_table18.PDF" (pdf, 4.61Kb)

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"AppendC_table19.PDF" (pdf, 4.22Kb)

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"AppendC_table20.PDF" (pdf, 3.89Kb)

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"AppendC_table21.PDF" (pdf, 3.9Kb)

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"AppendC_table22.PDF" (pdf, 4.21Kb)

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"AppendC_table23.PDF" (pdf, 4.74Kb)

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"AppendC_table24.PDF" (pdf, 3.98Kb)

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"AppendC_table25.PDF" (pdf, 4.04Kb)

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"AppendC_table26.PDF" (pdf, 4.7Kb)

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"AppendC_table27.PDF" (pdf, 4.46Kb)

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