Policymakers are currently considering proposals aimed at reducing the number of children without health insurance. The debate over various proposals could benefit from better information about the uninsured child population. To start, there is a lack of consensus about the number of uninsured children and the extent to which some of the uninsured are eligible for Medicaid but not participating. This study reviews the literature on children's health insurance pattens and Medicaid program participation. Specifically, this literature review focuses on (1) uninsured children -- how many are there, what are their characteristics, how long are they uninsured, and why are they uninsured; and (2) Medicaid eligibility, enrollment, participation rates, program dynamics, and measurement issues.
This literature review is the first task in an eight month research contract awarded by the Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), to Mathematica Policy Research, Inc. (MPR). The overall study objective is to improve understanding of the issues involved in analysis of children's health insurance patterns. This literature review was designed to identify key analytic questions that are not fully answered from current research. Subsequent tasks will include the design and implementation of further analyses of uninsured children using the Survey of Income and Program Participation (SIPP) and possibly other data as well. These analyses will benefit from the literature review, particularly with regard to the identification of methodological issues in measuring children's health insurance patterns. This review also provides a basis of comparison for key estimates produced in the additional tasks of this effort.
The first step in the literature review was to develop general criteria for inclusion of studies. These criteria were as follows:
- the analyses had to focus on one of the following: (1) uninsured children -- how many are there, how long are they uninsured, and why are they uninsured; (2) Medicaid eligibility, enrollment, participation rates, program dynamics, and measurement issues; and (3) participation rates of low-income children in related government programs, such as the former Aid to Families with Dependent Children (AFDC) and Food Stamps.
- the selected studies had to include empirical data analysis
- the studies had to be recent (since 1990) except for earlier works that were considered seminal
We obtained studies through an automated database search, reference lists from identified articles, the contents of current health policy journals, and the current research reviews in health policy newsletters. For the automated database search, we used the National Library of Medicine's Medical Literature Analysis and Retrieval System (MEDLARS). We also consulted with the ASPE Project Officer and other researchers involved in studying the uninsured to identify additional published and unpublished works. Although we obtained nearly seventy articles that initially met the stated criteria for this review, we limited the total number of articles reviewed by excluding articles that used older data that have since been updated or that simply presented overviews of the work done by other researchers that were already included in the review.
We begin this review in Chapter II by addressing the question, How many children are uninsured? We present key estimates of the uninsured using the most recent data available. We compare and contrast the estimates and discuss methodological issues involved in using survey data to make the estimates. In Chapter III, we present the characteristics of uninsured children as described in the literature. In Chapter IV, we analyze the literature on the question, How many uninsured children are eligible for Medicaid and what is the Medicaid participation rate for children? In this chapter we also describe the various ways that researchers have used survey data to estimate eligibility for the Medicaid program. As a point of comparison for Medicaid participation rates, we present literature on the participation rates for the AFDC and Food Stamp programs. In Chapter V, we analyze the literature on the characteristics of uninsured children who are eligible for Medicaid. In Chapter VI, we summarize our findings and discuss the next steps in this project.