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

05/12/1999

To estimate the impact of the Medicaid undercount on estimates of the number of uninsured children, we must work with estimates of children uninsured at a point in time rather than children ever uninsured during the year. Having Medicaid (or any other form of coverage) during a year does not imply that a child was insured throughout the entire year. Therefore, the impact of a Medicaid undercount on estimates of the number of children who were ever uninsured is too ambiguous to estimate.

Estimate FY93 FY94
TABLE 2: COMPARISON OF SIPP AND HCFA(now known as CMS) ESTIMATES OF CHILDREN EVER ENROLLED IN MEDICAID, FY93 AND FY94
Adjusted SIPP Panel Estimate 18,507,000 19,067,000
Age-adjusted HCFA(now known as CMS) Estimate 21,317,000 22,324,000
SIPP Undercount 2,810,000 3,257,000
Estimated Undercount as Percent of HCFA(now known as CMS) Estimate 13.2% 14.6%
SOURCE: Survey of Income and Program Participation, 1992 Panel, and HCFA(now known as CMS) 2082 Reports.

Our estimate of the Medicaid undercount represents children who were ever enrolled in Medicaid during a year. While the proportionate undercount need not be the same for the annual-ever and point-in-time statistics, we assumed that it was. In Table 3 we derive estimates of the size of the SIPP Medicaid undercount for September 1993 and 1994.4 We obtained 2.120 million as the estimated number of children who were covered but did not report Medicaid enrollment in September 1993 and 2.445 million as the number who were covered but failed to report their Medicaid enrollment in September 1994.

What proportion of the children who failed to report their Medicaid enrollment also failed to report any other kind of coverage? As we discussed earlier, some children (or their parents, in most cases) may have misreported their Medicaid coverage as another form of public or even private insurance. Others may have even had overlapping coverage and reported the other coverage rather than Medicaid.5 With no evidence to support specific assumptions about these proportions, we applied three alternative assumptions. We assumed that the proportion of unreported Medicaid enrollees who were classified as uninsured was either 95 percent, 85 percent, or 75 percent. These different assumptions may be considered to include our uncertainty about the incidence of duplication of individuals in the national Medicaid statistics.

Estimate   September 1993 September 1994
TABLE 3: IMPACT OF MEDICAID UNDERCOUNT ON THE ESTIMATED NUMBER OF CHILDREN UNDER 19 WHO WERE UNINSURED IN SEPTEMBER 1993 AND 1994
Adjusted SIPP Panel Estimates    
Number of Children Uninsured 9,493,000 9,317,000
Percentage of Children Uninsured 13.0% 12.6%
Number of Children Enrolled in Medicaid 13,962,000 14,312,000
     
Estimated Percentage of Medicaid Children Not Counted in SIPP 13.2% 14.6%
     
Undercount of Children Who Were Enrolled in Medicaid in September 2,120,000 2,445,000
     
Assumed Proportion of Unreported Medicaid Enrollees Counted as Uninsured    
Alternative 1 95% 95%
Alternative 2 85% 85%
Alternative 3 75% 75%
     
Estimated Number of Unreported Medicaid Enrollees Counted as Uninsured    
Alternative 1 2,014,000 2,323,000
Alternative 2 1,802,000 2,078,000
Alternative 3 1,590,000 1,834,000
     
Revised Estimate of the Number of Children Uninsured in September    
Alternative 1 7,479,000 6,994,000
Alternative 2 7,691,000 7,239,000
Alternative 3 7,903,000 7,483,000
     
Revised Estimate of the Proportion of Children Uninsured in September    
Alternative 1 10.2% 9.5%
Alternative 2 10.5% 9.8%
Alternative 3 10.8% 10.1%
     
SOURCE: Survey of Income and Program Participation, 1992 Panel.

The alternative assumptions imply that between 1.6 million and 2.0 million children were incorrectly counted as uninsured rather than insured in September 1993, and they lower the estimated number of uninsured children to between 7.5 million and 7.9 million--compared to the SIPP panel estimate of 9.5 million. Taking into account the Medicaid undercount implies that between 10.2 and 10.8 percent of children under 19 were uninsured in September 1993, compared to the SIPP panel estimate of 13.0 percent. For September 1994 the higher estimated Medicaid undercount yields estimates of the number of uninsured children that range between 7.0 million and 7.5 million compared to the SIPP panel estimate of 9.3 million. The alternative estimates of the proportion of children without health insurance range from 9.5 percent to 10.2 percent versus the SIPP panel estimate of 12.6 percent.

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