Children's Health Insurance Patterns: A Review of the Literature. 3. Community Tracking Study


Reschovsky et al. (1997) estimated the number of uninsured children age 0 to 18 using the CTS Household Survey. The CTS, sponsored by the Robert Wood Johnson foundation and conducted by the Center for Studying Health System Change, consisted of telephone interviews for 33,000 families, 11,600 of which had children. Information was gathered on all adults and one randomly chosen child in each household. Altogether, the survey has information on about 60,000 individuals. The data are weighted to be representative of the United States and are adjusted for nonresponse. Interviews took place, primarily via telephone, between July 1996 and July 1997. Like the MEPS, the CTS health insurance questionnaire is too large to include in this document; therefore, only the portions pertaining to Medicaid and the uninsured are presented in Appendix E.

Reschovsky et al. estimated that at any point in time from late 1996 to early 1997, there were approximately 8.8 million uninsured children, or about 12 percent of all children age 0 to 18. This is substantially lower than the estimate of 10.5 million uninsured children in 1995 produced by Fronstin and others using the March 1996 CPS. Reschovsky et al. pointed out that the difference between the two numbers most likely reflects methodological differences in how the two surveys asked about health insurance coverage. Reschovsky et al. asserted that the CTS estimate is lower in part because of methodological innovations in how insurance coverage is measured. With the CTS, persons who reported none of the various types of coverage when asked about each one individually, were then asked directly whether they were, in fact, uninsured. Some respondents at that point did report coverage. The CPS, in contrast, never directly asks respondents whether they are uninsured. Reschovsky et al. acknowledged, though, that the debate over whether the CPS is a point-in-time or period-of-time estimate confounds comparisons between the CTS and the CPS. If the CPS is a period-of-time estimate, then the CTS estimate, which is clearly a point-in-time estimate, would be expected to be higher rather than lower than the CPS estimate.

Reschovsky et al. did not adjust their estimate of uninsured children for possible underreporting of Medicaid in the CTS. Medicaid underreporting in the CTS appears to be even more substantial than in the CPS. Reschovsky et al. found that 9.8 million children age 0 to 17 were enrolled in Medicaid in the CTS versus 16.5 million in the CPS. Although the underreporting of Medicaid is quite high in the CTS, it is difficult to determine exactly the extent to which Medicaid may be underreported because the survey did not ask about Medicaid coverage in households where everyone reported private coverage. Therefore, the CTS missed Medicaid enrollees who were also covered by private insurance.(24) In any case, CTS estimates of the uninsured may be inaccurate because Medicaid enrollment appears to be underreported.