The Effects of Trigger Events on Changes in Children's Health Insurance Coverage. C. Frequency of Transitions

04/18/2000

Table 1 reports the average number of children who reported each major source of coverage between July 1993 and June 1994, including the number who were uninsured and the number who were reported as insured but with missing information on the actual source of coverage. The number of transitions out of each category of coverage (except the one indicating source not reported) and the number of transitions into each category are presented as well.

Altogether there were 23 million transitions among the types of coverage listed in Table 1, excluding any that began or ended with an unknown source. With an average population size of 70.7 million children over this period this amounts to one transition for every three children. Transitions out of uninsurance and transitions out of ESI totaled 7.8 million and 7.2 million, respectively. In addition to these there were 5.9 million transitions out of Medicaid and 2.4 million transitions out of other insurance. The 7.8 million transitions out of uninsurance compare to an average monthly uninsured child population of about 9 million. While the nearly 8 million transitions may reflect some children becoming reinsured twice during the year, we have shown elsewhere that turnover among uninsured children is very high, with about half the children who were uninsured at the end of a year being a different group of children than those who were without insurance at the beginning of the year (Czajka 1999). Transitions out of other insurance represented 87 percent of the number covered by other insurance at any one time, whereas the exits from Medicaid were about 45 percent of the average monthly reported enrollment. Transitions out of ESI were only 17 percent of the total ESI coverage, but this is hardly an insignificant fraction.

Source of Coverage

Average
Number of
Children
in Group

Number of
Transitions
Out of
Source

Percent
of
Source

Number of
Transitions
Into
Source

Percent
of
Source

Table 1: Changes in Children’s Health Insurance Coverage, July 1993 to June 1994

Employer-sponsored

41,846,000

7,178,000

17.2

7,151,000

17.1

Medicaid

13,192,000

5,879,000

44.6

5,472,000

41.5

Other insurance

2,792,000

2,438,000

87.3

2,694,000

96.5

Source not reported

3,888,000

--

--

--

--

Uninsured

9,001,000

7,830,000

87.0

8,038,000

89.3

Total

70,719,000

23,325,000

33.0

23,325,000

33.0

SOURCE: Survey of Income and Program Participation, 1992 Panel.

Transitions into each category of coverage were very nearly equal to the transitions out of each category--consistent with the findings of cross-sectional surveys that the distribution of children among types of coverage (or lack of coverage) changes very little from year to year. Comparison of the transitions out from and into each category of coverage suggests minimal net change in the number of children with ESI, a decline of about 400,000 in the number with Medicaid, and increases of 200,000 to 300,000 in the numbers with other insurance or no insurance.

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