Analysis of Children's Health Insurance Patterns: Findings from the SIPP. How Long Do Children Remain Uninsured?

05/12/1999

About half of all spells without insurance end in less than six months, but a quarter last for 12 months or more. By examining all spells that started in 1993 and following them to their conclusion or to the end of 1994, whichever came first, we could identify spells that continued for at least 12 months and those that ended in any number of months up to 12. More than 9 million new spells began in 1993 (including multiple spells experienced by the same children). So the number of new spells is comparable to the number of children who were without insurance at any one time. That half of these new spells ended in less than six months helps to explain why the number of children who were uninsured for any part of 1993 is so much higher than the number who were uninsured at any one time during the year. Nevertheless, a significant fraction of the new spells--about 24 percent--did last for 12 months or more. Therefore, new spells that started in 1993 added more than 2.3 million children, ultimately, to the number of long-term uninsured (based on a common 12-month definition of long-term).

Nearly half of the children who are without insurance at any one time have already been uninsured for 12 months or more. Of the more than 9 million children who were uninsured in September 1993, 47 percent had been uninsured for at least 12 months, while only 37 percent had been uninsured for less than 6 months. We projected that fewer than 20 percent of these 9 million children would end their spells (become insured) in less than six months and that nearly two-thirds would be uninsured for 12 months or more. Essentially, long spells are more likely to be ongoing at any one time than short spells, so the uninsured population at a point in time, includes a higher proportion of long-term uninsured than we find among all new spells.

The distribution of spell durations is important because brief spells, moderate spells, and long spells without insurance carry very different policy implications. By definition, very short spells are transitional. That is, with no intervention, these spells will end quickly, the assumption being that these uninsured children are in transition from one source of insurance to another (perhaps because of a waiting period for private insurance). These transitional periods, or short spells, demand a different policy response, if any, than periods in which the near-term availability of coverage may be uncertain. Even spells of six months or so may require a different policy approach than much longer spells--both from the standpoint of program efficiency and potential clients' perceived needs for coverage.

When a spell starts, how do we determine if it is going to be a short spell or a long spell? The surest approach is to wait. The CHIP regulations explicitly address the differential treatment of short-term and long-term spells, and the federal guidelines allow waiting periods as a device for countering the potential crowd-out of private insurance.

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