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Ann Arbor Research Conferences
Health Insurance Coverage: To Have and To Hold, In Sickness and In Health?
September 7 - 8, 2006
Ann Arbor , MI
Among those who are without health insurance, at least 80 percent had it but lost it. Health insurance status is not an unchanging personal characteristic but something that changes over time. Each of the eight papers addressed some aspect of the dynamics of health insurance coverage or the implications of change in health insurance status. |
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| Participant List | Papers Presented |
Author |
Conference Paper |
Abstract |
Fairlie, Rob
London, Rebecca |
Race, Ethnicity and the Dynamics of Health Insurance Coverage (PDF) |
Using matched data from the 1996 to 2004 Current Population Survey (CPS), we examine racial patterns in annual transitions into and out of health insurance coverage. We first decompose racial differences in static health insurance coverage rates into group differences in transition rates into and out of health insurance coverage. The low rate of health insurance coverage among African-Americans is due almost entirely to higher annual rates of losing health insurance than whites. Among the uninsured, African-Americans have similar rates of gaining health insurance in the following year as whites. Estimates from the matched CPS also indicate that the lower rate of health insurance coverage among Asians is almost entirely accounted for by a relatively high rate of losing health insurance. In contrast to these findings, differences in health insurance coverage between Latinos and whites are due to group differences in both the rate of health insurance loss and gain. Using logit regression estimates, we also calculate non-linear decompositions for the racial gaps in health insurance loss and gain. We find that two main factors are responsible for differences in health insurance loss between working-age whites and minorities: job loss and education level. Higher rates of job loss account for 30 percent of the health insurance gap for African-Americans and Asians, and 16 percent of the health insurance gap for Latinos. Lower levels of education explain roughly 15 percent of the gap for African-Americans and Latinos (Asians' higher levels of education serve to close the gap). Higher rates of welfare and SSI participation among African-Americans also serve to widen the gap in health insurance loss by 8 percent.
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| Gresenz, Carole
Rogowski, Jeanette
Escarce, Jose |
Patterns of Care Among the Uninsured (PDF)
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A number of studies have analyzed utilization of care among the uninsured, but few have addressed how use of care may vary over the course of an episode of being uninsured or across episodes of varying duration. This research models the probability that an uninsured individual has (a) any medical expenditures or charges, and (b) any
office-based visit during each month of an uninsured episode. The results suggest that utilization is largely unrelated to episode length but is related to the number of months since inception, with rising utilization during the first year of an episode. |
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| Harrington, Mary
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The Effect of a Health Care Visit on Transitions to Medicaid or SCHIP among Uninsured Low-Income Children (PDF) |
Despite major efforts to expand public program eligibility to uninsured children,
many low-income children remain unenrolled. Some have argued that we should not be as
concerned about these eligible, uninsured children because they can and will be become enrolled
with they get sick and present for a health care visit. This study addresses the question of
whether uninsured low-income children do in fact become insured when they are brought in for
care. It uses longitudinal data from two panels of the Medical Expenditure Panel Survey
(MEPS) to model the effect of a health care visit on transitions from uninsured to insured among
low-income children. An instrumental variable approach, using data on sibling accidents, is
employed to overcome problems associated with the endogenous relationship between visits and
enrollment. Results suggest that many low-income uninsured children are not becoming enrolled
after a health care visit. Outreach efforts such be bolstered and strengthened to address barriers
that keep parents from enrolling their children in public coverage. |
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Kuttner, Hanns
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Shocks to Income and Employment and Loss of Health Insurance (PDF) |
Health insurance tied to employment is the most common source of health insurance for non-elderly Americans, and loss of employment-related coverage held in the worker's own name is the most common route into being uninsured. While losing a job is the most common reason for a job to end, job loss, including being laid off and employer closing, accounts for only one in five job separations.
The risk of losing coverage and becoming uninsured varies with the degree of control the worker has for the reason the job ends. Those who are fired face the highest risk. Those who leave because job hours or pay were unsatisfactory were as likely to become uninsured as those who lost their job. Those who retire face the lowest risk.
A job ending can also bring a large income negative income shock. Even where income shocks are large, the shock size has little effect on the probability of losing coverage. Compared to someone who experiences no income loss, a worker who loses a job and experiences the median monthly income change (-33%) faces only a two percentage point higher risk of losing coverage and becoming uninsured. |
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| Levy, Helen
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Health Insurance and the Transition to Financial Adulthood (PDF) |
The probability of being uninsured peaks in early adulthood, with one third of young adults uninsured in their early 20s. The increase in uninsurance begins in the late teenage years, driven by the loss of parental health insurance and, for men, the loss of public coverage. Rates of uninsurance decline several years later when young adults begin to obtain employer-sponsored coverage on their own. But the gap between losing childhood coverage and gaining one"s own coverage means that the median young adult will be uninsured at some point in his or her late teens or early twenties. Employment instability explains a significant fraction of the high rate of uninsurance among the young. When combined with other factors (marital status, parenthood, family income), observable characteristics can explain about half of the spike in uninsurance in young adulthood. This suggests that uninsurance in early adulthood is related to the more general lack of finam cial maturity that characterizes young adults, but is not entirely explained by it. Whether the residual excess insurance coverage is due to adverse selection in insurance markets or attributes I have not measured, such as risk preferences, remains to be deteremined. |
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| Mortensen, Karoline |
Emergency Department Utilization of the Intermittently Uninsured (PDF) |
This paper explores evidence on whether individuals with a transition in health insurance coverage are more likely to have an emergency department (ED) visit, type of transition that is associated with likelihood of visit, and insurance status at visit. I find that the intermittently uninsured, specifically those who gain public coverage during the panel, are more likely than those with stable insurance coverage or continuous lack of coverage to have an ED visit. Using fixed effects analysis to study only individuals with intermittent coverage, I find their visits were more likely to be covered by public or private coverage than to be uninsured. |
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Rutledge, Matt
McLaughlin, Catherine
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Coverage Transitions in Hispanic vs. White Non-Hispanic Populations: Trends in the Last 20 Years (PDF) |
It is well documented that Hispanics in the U.S. lack health insurance coverage at much higher rates than white non-Hispanics. What is less well known is how that gap has changed over the last twenty years in response to changes in macroeconomic conditions and federal and state policies, and how differential insurance transition probabilities have contributed to that gap. Using a pooled panel from the Survey of Income and Program Participation, we look at differences in the frequency of transitions into and out of insurance coverage over the 1983 to 2003 period as well as differences in the likelihood of obtaining or losing private or public coverage. Our results indicate that the gap in coverage between Hispanics and white non-Hispanics is increasing, even after accounting for differences in income, human capital, and citizenship. The widening of the gap is driven primarily by Hispanic non-citizens, who have grown more likely to be uninsured, and less likely to transition into coverage, over the sample period. |
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Simon, Kosali
Schroeder, Mathis |
The Effect of Involuntary Job Displacement on Health Insurance (PDF) |
In this paper, we use panel data to test whether involuntarily displaced workers suffer losses in their health insurance coverage relative to similar workers who are not displaced. We find that workers who are subsequently displaced from jobs are less likely to have own-employer provided health insurance than otherwise similar workers who are not displaced, and that this difference starts up to 18 months prior to displacement. Once re-employed, formerly displaced workers fare worse than other new workers who voluntarily left their previous jobs in terms of finding own employer health insurance on the new job, although all new workers experience some gains in health insurance over time. |
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