When Insurance Status Is Not Static: Insurance Transitions of Low-Income Children and Implications for Health and Health Care
Section snippets
Sample
The 1999 NSAF (response rate = 70%) includes data on over 48 000 households and is publicly available.17 Data collection methods and estimation procedures were used to minimize errors in data collection. NSAF estimates were comparable with Current Population Survey estimates. An overview of data collection methods used and survey reliability are available from the Urban Institute.18 The survey was conducted in English and Spanish, by telephone, and in person for households without telephones.
Study Question 1: How Many Low-Income Children in the United States Experience Insurance Transitions?
In 1999, 27.93 million children lived in households <200% of the federal poverty line (40.8% of the weighted NSAF sample), distributed across 9 different categories of RIH (Figure). Although the majority of low-income children had stable insurance coverage over the preceding 12 months, 5.7 million (20%) experienced a transition in insurance status. Among children who experienced transitions, 36% shifted from uninsured to insured and 32% shifted from insured to uninsured; the remainder shifted
DISCUSSION
Our analysis illustrates that the health insurance status of many low-income children is not static. In this national sample, almost as many low-income children were affected by insurance transitions as were continuously uninsured children in 1999. Transitions were not experienced equally among children of different ages, races or ethnicity, parental education, and spouse or partner status. Although differences by age, race or ethnicity, and parent characteristics are familiar from
CONCLUSION
Notwithstanding these limitations, this analysis illustrates that classifications of children by point-in-time or current insurance status include more within-group heterogeneity than has been previously recognized. Consequently, efforts to measure children's current insurance status without considering recent transitions may provide an incomplete picture of children's health status and access to care for a substantial proportion of low-income children. Previous analyses of the longitudinal
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