February 2004/Issue 10 Translating Research to Policy A Comparison of Children’s Uninsurance Rates Across the States 1995 - 97 to 2000 - 02 In the mid nineties, the rates of uninsured for the population as a whole2, but decreased children climbed following the enactment of for children.3 Despite this decrease in private welfare reform, as many previously insured coverage, the Current Population Survey’s children became ineligible for Medicaid.1 In (CPS) three-year average uninsurance 1997, the State Children’s Health Insurance estimates show that more American Program (SCHIP) was created to increase children had health insurance coverage in insurance coverage for low income children 2000-02 than in 1995-97. In 2002, ineligible for Medicaid as part of the Title approximately 10.2 million children did not XXI of the Social Security Act. In an earlier have health insurance, down from over 11.5 SHADAC Issue Brief, we compared million in 1997. This suggests that SCHIP changes in children’s uninsurance rates may be helping to reduce the total number across states as an indication of SCHIP of children without health insurance success (see Issue Brief Six.) Here we coverage. update the insurance rates using the newly released 2002 CPS data. Here, we assess the overall change in health insurance coverage among children Between 1997 and 2000, all states developed across the states for the six-year time and implemented programs under SCHIP. period spanning Welfare Reform and the The form of SCHIP programs and the enactment and implementation of SCHIP. efforts to enroll new children vary by state. Estimates used for all comparisons between Many states, such as Tennessee and 1995 and 2002 are adjusted for the Missouri, have made significant outreach verification question added to the CPS efforts to identify and insure children who health insurance module in 2000. With the are not covered by a health insurance plan. exception of Figure 1, 3-year averages for 1995-97 and 2000-02 are used to estimate Parallel to SCHIP implementation, uninsurance rates. For all observations, we employer-sponsored coverage grew slightly used unverified data.4,5 CHANGES IN THE NUMBER OF UNINSURED year averages, which is more reliable then the two-year average previously used. Further, the current analysis CHILDREN FROM 1995-97 TO 2000-02 included eighteen-year-old children, while the previous Although an important catalyst, SCHIP was only one excluded this population. It is appropriate to include factor in the increase in coverage. SCHIP outreach eighteen year olds, as they are eligible for SCHIP efforts led to an increase in Medicaid enrollment.6 A programs. We believe that our current estimate is more robust economy at this time was also an important reliable because of these two changes, indicating that contribution to the decrease in uninsured children.7 SCHIP has had a greater impact across states than previously noted. VARIATION IN PERCENT CHANGE In general, states with the lowest uninsurance rates for ACROSS STATES children in 1995-97 (Minnesota, Wisconsin, and Table 1 below shows that seventeen states experienced Vermont) retain the lowest rates in 2000-2002. In a statistically significant decrease in their rate of addition, many of the states with the highest uninsured children. This analysis shows greater uninsurance rates in 1995-97 (Arizona, Arkansas, and improvement in uninsurance rates than an earlier Louisiana) were among those with the most noticeable analysis done by SHADAC (see Issue Brief Six.) This decreases in uninsured children over the six-year can be attributed to two methodological changes. First, period. New York led the nation with the largest the current uninsurance rate was calculated for three- decrease in the number of uninsured children (almost 150,000) from 1995-97 to 2000-2002, reducing the A few states have shown little or no improvement. In child uninsurance rate by approximately 2.5% over the 2000-02, over one in five children in Texas remain time period. Arkansas led the nation with the largest uninsured, and in New Mexico, Arizona, Florida, and decrease in the percent of uninsured children from Nevada over one in six children have no health 1995-97 to 2000-2002, reducing the child uninsurance coverage. An additional six states that did not have rate by approximately 9.3%, reflecting a reduction of significant decreases in their rates of uninsured almost 80,000 children. children remain above the national average of 13.3%. Table 1. Three-Year Average Uninsurance Rates for Children 1995-97 to 2000-02 DISTRIBUTION OF UNINSURED CHILDREN percent of all the nation’s children live in these states. By contrast, the large number of uninsured children in Uninsurance among children varies a great deal across New York and Illinois is a function of the large total the states, with the highest rates concentrated in the populations of children in those states, not of high Southwest region. Almost forty percent (38.3%) of all uninsurance rates. 9.8 percent of the nation’s uninsured uninsured children in the U.S. live in three states – children live in New York and Illinois, but 10.7 percent of California, Texas, and Florida - while only twenty-seven all of the children in the country reside in these two states. CONCLUSIONS This continued assessment shows further decrease in the uninsurance rates for With increased federal flexibility, states have children following the implementation of been able to tailor SCHIP and Medicaid SCHIP. While this analysis did not control programs to their specific needs. However, for local environment and other effects, it this flexibility in the use and design of the is evident that many states had great success programs has made comparative analysis more in lowering their children’s uninsurance difficult. Nonetheless, monitoring trends at rate over this six-year period. These the state level is critical to understanding the accomplishments are encouraging and changing dynamics of health insurance should continue to be watched to monitor coverage. the effects of changes in the trend over time. NOTES 1 Guyer, Jocelyn. Uninsured Rates of Poor Children Declines but Remains Above Pre-welfare Reform Levels. Center on Budget and Policy Priorities 2000. Washington, DC. http://www.cbpp.org 2 Holahan, John; Pohl, Mary Beth. Changes in Insurance Coverage: 1994 – 2000 and Beyond. Health Affairs Web Exclusive. April 3, 2002. 3 Cunningham, Peter J.; Reschovsky, James D.; Hadley, Jack. SCHIP, Medicaid Expansions Lead to Shifts in Children’s Coverage. Center for Studying Health System Change. Issue Brief No. 59, http://.www.hschange.org/CONTENT/508/ 4 All SCHIP statistics have been taken from SCHIP Annual Reports. Uninsurance rates, Medicaid rates, and unemployment statistics have been taken from the CPS. 5 State Health Access Data Assistance Center, (SHADAC) Issue Brief #4: What is Behind the 8 Percent Drop in Uninsurance: Changes in CPS Health Insurance Measurement and the Effect on State Policy. 6 Centers for Medicare and Medicaid Services. The State Children’s Health Insurance Program Annual Enrollment Report. Federal Fiscal Year 2001; October 1, 2000 – September 20, 2001. February 6, 2002. 7 Park, Michael H.; Cunningham, Peter J. Some Communities Make Progress in Reducing Children’s Uninsurance. Center for Studying Health System Change 2000. Data Bulletin No. 19. http://www.hscange.org State Health Access Data Assistance Center (SHADAC) | University of Minnesota School of Public Health 612-624-4802 | fax: 612-624-1493 | www.shadac.org IB-10-204