The Effects of Trigger Events on Changes in Children's Health Insurance Coverage. 1. Transitions Between Types of Coverage

04/18/2000

Sample counts and population estimates of the transitions that are the focus of this study are reported in Table 2A along with the percentage distribution of the total transitions. The transitions are grouped by the status of origin. In Table 2B the transitions are grouped by the destination status. For the 12-month period from July 1993 through June 1994 the SIPP provides 3,753 sample observations of the 12 types of transitions.

Just over half of the children who left ESI became uninsured--more than 3.6 million. Those who obtained coverage from another source instead were about equally likely to enroll in Medicaid or to obtain other insurance. The 7.8 million children who left uninsurance obtained ESI or enrolled in Medicaid with about the same frequency whereas the 5.9 million who left Medicaid ended up uninsured more than two times out of three. Of those who obtained insurance from another source after leaving Medicaid, 90 percent or 1.8 million out of 2 million obtained ESI. Children who left other insurance tended to report ESI as their next source of coverage. Nearly three out of four or 1.8 million children who left other insurance did so while about half a million became uninsured and 100,000 enrolled in Medicaid.

Something else that is evident in Table 2A is that forward and backward transitions between a given pair of coverage statuses tended to occur with similar frequency. For example, 3.6 million children moved from ESI to uninsured during the year while 3.5 million moved from uninsured to ESI. Similarly, 3.6 million moved from uninsured to Medicaid while 3.9 million moved from Medicaid to uninsured; 1.7 million moved from ESI to Medicaid while 1.8 million moved from Medicaid to ESI; and 1.8 million moved from ESI to other insurance while 1.8 million also moved from other insurance to ESI.

These patterns of reciprocal movement help to explain why we see relatively little change in the distribution of children's health insurance coverage between one year and the next despite observing such a high volume of transitions. The near equivalence of forward and reverse transitions between almost any given pair of insurance types prompted us to ask whether a large part of this phenomenon could be attributed to behavior at the micro-level--that is, individual children moving from one type of coverage to another and then returning to their original coverage after a relatively short amount of time. 8 We found that this was indeed the case but to differing degrees for different types of transitions.

Type of Transition Sample
Count
Population
Estimate
Percent of
All Transitions
TABLE 2A: SAMPLE COUNTS AND POPULATION ESTIMATES OF SELECTED TRANSITIONS IN CHILDREN'S HEALTH INSURANCE COVERAGE: JULY 1993 TO JUNE 1994
 
All Children Under 19 11,666 70,719,000  
 
Total Number of Transitions 3,753 23,325,000 100.0
 
Transitions from ESI to: 1,203 7,178,000 30.8
   Uninsured 605 3,619,000 15.5
   Medicaid 278 1,720,000 7.4
   Other Insurance 320 1,840,000 7.9
 
Transitions from Uninsured to: 1,237 7,830,000 33.6
   ESI 584 3,546,000 15.2
   Medicaid 549 3,640,000 15.6
   Other Insurance 104 645,000 2.8
 
Transitions from Medicaid to: 897 5,879,000 25.2
   Uninsured 578 3,872,000 16.6
   ESI 285 1,798,000 7.7
   Other Insurance 34 209,000 0.9
 
Transitions from Other Insurance to: 416 2,438,000 10.5
   ESI 306 1,777,000 7.6
   Uninsured 91 547,000 2.3
   Medicaid 19 113,000 0.5
SOURCE: Survey of Income and Program Participation, 1992 Panel.

NOTE: The number of children reported in the first line refers to the average number under 19 at any one time, whereas the counts of transitions represent annual estimates.

Type of Transition Sample
Count
Population
Estimate
Percent of
All Transitions
TABLE 2B: SAMPLE COUNTS AND POPULATION ESTIMATES OF SELECTED TRANSITIONS IN CHILDREN'S HEALTH INSURANCE COVERAGE: JULY 1993 TO JUNE 1994
 
All Children Under 19 11,666 70,719,000  
 
Total Number of Transitions 3,753 23,325,000 100.0
 
Transitions to ESI from: 1,175 7,121,000 30.5
   Uninsured 584 3,546,000 15.2
   Medicaid 285 1,798,000 7.7
   Other Insurance 306 1,777,000 7.6
 
Transitions to Uninsured from: 1,274 8,038,000 34.5
   ESI 605 3,619,000 15.5
   Medicaid 578 3,872,000 16.6
   Other Insurance 91 547,000 2.3
 
Transitions to Medicaid from: 846 5,472,000 23.5
   Uninsured 549 3,640,000 15.6
   ESI 278 1,720,000 7.4
   Other Insurance 19 113,000 0.5
 
Transitions to Other Insurance from: 458 2,694,000 11.5
   ESI 320 1,840,000 7.9
   Uninsured 104 645,000 2.8
   Medicaid 34 209,000 0.9
SOURCE: Survey of Income and Program Participation, 1992 Panel.

NOTE: The number of children reported in the first line refers to the average number under 19 at any one time, whereas the counts of transitions represent annual estimates.

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