Health Insurance Dynamics (HIDyn)
Publications and Presentations from Filling the Gaps
"Battery-Powered" Health Insurance? Stability in Coverage of the Uninsured
by Pamela Farley Short and Deborah R. Graefe
Health Affairs, 22(6): 244-255 (2003).
Abstract
This study assesses the stability of Americans' health insurance status over a four-year period. Relatively few Americans were continuously uninsured for the four years 1996 to 1999, but a sizable number of the uninsured lacked a stable source of coverage. At least as many people were repeatedly uninsured as experienced a single gap in otherwise stable coverage. Given these dynamics, policymakers should think of "uninsured" as referring not to people, but rather to gaps in coverage over time. Reforms that stop short of universal coverage should be evaluated in terms of their likely effects on the continuity and stability of coverage.
Churn, Churn, Churn: How Instability of Health Insurance Shapes America's Uninsured Problem (.pdf document)
By Pamela Farley Short, Deborah R. Graefe, and Cathy Schoen
Task Force on the Future of Health Insurance Issue Brief. New York: The Commonwealth Fund (November 2003).
Abstract
This issue brief profiles populations at risk for being uninsured and describes the considerable churning in health insurance coverage experienced by Americans. This analysis of the 1996 panel of the Survey of Income and Program Participation (SIPP) supplements earlier results showing gaps in coverage to be as important for understanding the uninsured problem as the high number of people uninsured at any point in time. Findings point to the need for policies that emphasize retention of insurance, permitting people to stay insured when they have changes in employment, income, or family circumstances.
Sizing Up Gaps in Health Insurance Over Time (under review)
By Pamela Farley Short and Deborah R. Graefe
Task Force on the Future of Health Insurance Issue Brief.. New York: The Commonwealth Fund (2004).
Abstract.
Solutions to the uninsured problem can be designed to fill gaps in time without insurance coverage, such as with COBRA and transitional medical assistance, or to cover the people at greatest risk for long-periods of being uninsured, such as with SCHIP's extension of eligibility for publicly-sponsored coverage to near-poor children. This issue brief demonstrates how application of these different strategies are best suited for serving two different types of experience without health insurance. Identification of these different types - repeatedly moving in and out of coverage versus having no coverage for extended spells - requires longitudinal data collected continuously over longer periods of time. The 1996 panel of the Survey of Income and Program Participation (SIPP) provides a unique opportunity for such analysis.
Extending Health Insurance for Low-Income Americans (under review)
by Pamela Farley Short and Adetokunbo Oluwole.
Abstract
Lack of continuity is a major shortcoming of American health insurance, particularly for low-income Americans. This article reports on simulations, using data from the Survey of Income and Program Participation for 1996 through 1999, that investigated the potential effects of extending enrollment in public or private insurance to fill gaps in the health insurance of low-income Americans over time. An 18-month extension of all employer insurance obtained by active workers or continuous annual enrollment in Medicaid and SCHIP would do relatively more to improve stability and continuity than to reduce the number of people who are uninsured. Public insurance would have to play a significant role in any extension strategy intended to cover large numbers of the uninsured at low income levels. Because their insurance is currently less stable, low-income children would benefit relatively more from these reforms than adults.
Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help
By Sara R. Collins, Cathy Schoen, and Katie Tenney
New York: The Commonwealth Fund. Task Force on the Future of Health Insurance Issue Brief, May 2003.
Abstract
Frequent losses of health insurance place the health of young adults at risk and subject them or their families to financial stress just as they are starting out in the workforce. This issue brief uses data from several sources to assess the scope of the health insurance problem facing young adults, its causes and implications, and what can be done about it. The analysis includes some targeted policy steps that could help young adults stay insured as they make the transition to independent living.
Unequal Access: Insurance Instability Among Low-Income Workers and Minorities (.pdf document)
by Michelle M. Doty and Alyssa L. Holmgren
Issue Brief. New York: The Commonwealth Fund (April 2004)
Abstract
Analysis of health insurance coverage and employment patterns from 1996
through 1999 reveals even higher uninsured rates and greater insurance
instability among low-income adults and minorities than had been
previously documented. Most low-income adults worked during the four
years, but many had no or only intermittent job-based coverage.
Low-income Hispanic adults were particularly hard hit: more than
one-third (37%) of this group were never insured with private coverage,
even though they worked all four years. Policies that expand coverage to
low-income families could help reduce racial and ethnic disparities in
access to care.
Health Insurance Dynamics: Implications for Coverage Reforms
By Pamela Farley Short
Presented at AcademyHealth, June 1, 2003.
Abstract.
This presentation described characteristics of individuals who move on and off public and private coverage.
Gaps and Transitions in Health Care Access: Welfare Reform and America's Uninsured Poor Children
by Deborah Graefe, Pamela Farley Short and Adetokunbo Oluwole.
Poster presented at 2003 Annual Meeting of the Population Association of America, Minneapolic, MN, May 1-3;
Abstract
As millions of poor mothers moved from welfare to work in accordance with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), two-thirds of poor and near-poor children went a month or more without health insurance coverage between 1996 and 1999. Despite most states' provision of Transitional Medical Assistance (TMA) and implementation of the State Children's Health Insurance Program (SCHIP) in 1997, poor children experienced considerable instability in health insurance coverage. This paper used data from the 1996 Panel of the Survey of Income and Program Participation (SIPP) in a longitudinal research design to document poor children's transitions from publicly provided insurance coverage over the 4 years following welfare reform. Only 18% of children with family incomes below the poverty line remained on Medicaid/SCHIP continuously. Discrete-time event history analysis was used to determine children's retention of Medicaid in connection with families' loss of cash assistance.
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