The Effects of Trigger Events on Changes in Children's Health Insurance Coverage. How Often Do Children Change Coverage?

04/18/2000

We examined changes among three sources of coverage--employer-sponsored insurance (ESI), Medicaid, and other, primarily private insurance--plus a fourth status: uninsured. Table 1 summarizes our findings. It shows how children were distributed by major source of coverage and how many changes in coverage, or transitions, were recorded among these major types of coverage over a 12-month period. Transitions out of uninsurance and transitions out of ESI were the most common at 7.8 million and 7.2 million, respectively, although the 5.9 million transitions out of Medicaid were not much fewer. What is particularly important to note is how the numbers of changes in coverage compare to the average numbers of children who were in these states at any one time. The total transitions out of uninsurance were 87 percent of the number who were uninsured at any one time, and the transitions out of other insurance were 87 percent of the average number covered by other insurance. Transitions out of Medicaid were about 45 percent of the average enrollment while transitions out of ESI were only 17 percent of the total covered.

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 of the coverage statuses were nearly identical to the exits, explaining why we see so little change in the aggregate distribution of coverage from year to year. The uninsured and those with other insurance grew by 200 to 300 thousand over the year while Medicaid declined by about 400 thousand.

Destination statuses were distributed very differently depending on the type of coverage that children were leaving. Just over half of the children who left ESI became uninsured--more than 3.6 million. The remainder were about equally likely to enroll in Medicaid or to obtain other insurance. The 7.8 million children who left uninsurance obtained ESI or Medicaid with about equal frequency whereas the 5.9 million who left Medicaid ended up uninsured more than two times out of three.

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