oversight

Uninsured Children: Estimates of Citizenship and Immigration Status in 1995

Published by the Government Accountability Office on 1997-05-27.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

OJGA   United States
       General Accounting Office
       Washington, D.C. 20548

       Health, Education and Human Services Division                             158730

       B-276884

       May 27, 1997

       The Honorable Daniel Patrick Moynihan
       Ranking Minority Member
       Committee on Finance
       United States Senate

       Subject: Uninsured Children: Estimates of Citizenship and Immigration Status
                in 1995

       Dear Senator Moynihan:

       The number of uninsured children under 18 years old has grown 20 percent
       since 1987, reaching 9.8 million in 1995, as the percentage of children with
       private health insurance coverage declined. In response to concern about
       children left without coverage, this Congress has introduced several proposals
       to expand health insurance for children. Some members of the Congress,
       however, may prefer to reserve any proposed benefits for citizens or certain
       categories of legal residents. To help the Committee with its deliberations on
       approaches to insuring children, you asked us to provide you with information
       on the citizenship and immigration status of uninsured children under 18 years
       old.

       To develop this information, we used data from the March 1996 Bureau of the
       Census' Current Population Survey (CPS), which includes information on health
       insurance coverage during 1995. The CPS reports children as uninsured if they
       had no reported source of public or private health insurance at any time during
       1995. We matched records for children under 18 years old with records for one
       of their parents (or other relative if no parent record matched) aged 18 to 64
       years old to report on both uninsured children and at least one of their parents.
       We are reporting birth and naturalization status on only those children whose
       records we matched with their parents' records. (See enclosure I for more
       information on the CPS and our methodology.) The numbers and percentages
       are estimates and depend upon parents' or other household members' self-
       reporting of household members' birth, citizenship, and insurance status. We
       performed our work in April 1997 in accordance with generally accepted
       government auditing standards.



                                    GAO/HEHS-97-126R Uninsured Children and Immigration, 1995


                              /
                         0;;876                (- VI3D
BE-276884

According to U.S. law, people may be citizens due to birth or naturalization. People born
in the United States are U.S. citizens, no matter what the immigration or residency status
of their parents.' People who are born abroad of U.S. citizens are also U.S. citizens. In
addition, people born in Puerto Rico and these outlying areas-Guam, the Commonwealth
of the Northern Mariana Islands, and the Virgin Islands-are citizens. People born in
American Samoa are citizens if one of their parents is a citizen and that parent has been
physically present in the United States or an outlying possession for at least 1 year before
the birth of the child. Foreign-born people may enter the United States legally as
nonimmigrants or immigrants. Generally, nonimmigrants stay here temporarily, while
immigrants reside here permanently and may apply for citizenship after 5 years of U.S.
residence. Some foreign-born people enter or live in the United States illegally.

The CPS has no information on whether a person is in the country legally or illegally.
The survey does classify individuals as (1) native, born in the United States; (2) native,
born in Puerto Rico or U.S. outlying areas; (3) native, born abroad of a U.S. parent; (4)
foreign born, U.S. citizen by naturalization; and (5) foreign born and not a naturalized U.S.
citizen. According to one researcher familiar with the CPS and immigrant matters, the
CPS reports more foreign-born people and more foreign-born naturalized citizens than can
be accounted for through legal immigration and naturalization data from the Immigration
and Naturalization Service.

Our analysis of the CPS showed the following for 1995:

- Among uninsured children, almost. 9 out of 10 children were born in the United States.
  Most of the rest were foreign-born noncitizen residents. (See enclosure II.)

- Although foreign-born noncitizen children constituted only 3.3 percent of U.S. children
  in 1995, they accounted for over 9 percent of all uninsured children. Almost 37 percent
  of foreign-born noncitizen children were uninsured in 1995-about 847,000 children. In
  comparison, only 12.5 percent of IJ.S.-born children were uninsured-but this group
  numbers over 8,250,000 children. (See enclosure II.)

- A parent of an uninsured child was more likely to be foreign born than were his or her
  children. Almost 3 out of 10 of the parents who matched with uninsured children were
  foreign born. Four-fifths of these foreign-born parents were not citizens. (See
  enclosure III.)

For more detail, see attached tables and figures in enclosures II and III.



'Some minor exceptions exist, such as children of diplomats.

2                                       GAO/HEHS-97-126R   Uninsured Children and Immigration, 1995
B-276884

Because this information is based on data and procedures used in the previous GAO
reports listed at the end of this letter, we did not seek agency comments on a draft of this
correspondence.



We will make this correspondence available to others on request. Please contact me at
(202) 512-7107 if you or your staff have any questions. The information in this letter was
prepared by Michael Gutowski, Sheila Avruch, and Paula Bonin.

Sincerely yours,



Jonathan Ratner
Associate Director, Health Financing and Systems Issues

Enclosures




3                                    GAO/HEHS-97-126R   Uninsured Children and Immigration, 1995
ENCLOSURE I                                                                       ENCLOSURE I

                                       METHODOLOGY

To examine insurance coverage and; birth and immigration status of children and a parent,
we analyzed the Bureau of the Census' Current Population Survey (CPS) for March 1996,
which reported on insurance status in 1995. The CPS is the source of official government
statistics on employment and unemployment. An important secondary purpose of the
survey is to collect demographic information on the U.S. population, including age, sex,
race, marital status, educational attainment, and family structure. The CPS conducted
every March also collects additional information on work experience, income, noncash
benefits, and health insurance coverage of each household member during the previous
year.

The CPS sample is based on the civilian, noninstitutionalized population of the United
States. It includes about 48,000 households with approximately 94,000 people 15 years
old and older and approximately 28,000 children under 15 years old. It also includes
Armed Forces members living in households with civilians either on or off base. The
households sampled by the CPS are scientifically selected on the basis of area of
residence to represent the United States as a whole, individual states, and other specified
areas. Since the CPS is based on a sample of the U.S. population, weights are used to
compute estimates for the total population. The weights are computed on the basis of
information from the decennial censuses.

We have used the CPS for several years to analyze insurance coverage and other
demographic characteristics of U.S. children and their parents.2 The CPS contains
records for households, families within a household, and persons within families. The
records are linked so that an individual's record can be related to other family or
household members' records.

To report on parents of children under age 18, we matched each child's record with the
record of a parent or other relative in a parental role aged 18 to 64 in the same
household. Every child's record did not match with a parent or other relative's record.
Of the estimated 9.8 million uninsured children, we matched records from the CPS sample
that represent 9.2 million (94 percent of the children). For birth and naturalization status
of uninsured children, we are only reporting on those children whose records we matched
with their parents' records.


2 Many  of the related GAO reports at the end of this letter have information from the CPS--some
from previous years. For example, see Health Insurance for Children: Private Insurance
Coverage Continues to Deteriorate (GAO/HEHS-96-129, June 17, 1996) and Health Insurance for
Children: Many Remain Uninsured Despite Medicaid Expansion (GAO/HEHS-95-175, July 19,
 1995).

4                                       GAO/HEHS-97-126R   Uninsured Children and Immigration, 1995
ENCLOSURE II                                                                        ENCLOSURE II
                      DATA ON ESTIMATED BIRTH. CITIZENSHIP,
                     AND NATURALIZATION STATUS OF CHILDREN

Figure II.1: Estimated Birth and Citizenship Status of All U.S. Children and Uninsured
Children, 1995




                     All U.S.                                    Uninsured
                     Children                                     Children



                                                                                           9.0o%

                                          3.0%
             ~95.0                    2.0°                                               :20%
                                                                                        2.0%




                                                    89.0%0\




                                        Foreign Noncitizen
                                      ] U.S. Bom
                                     I[ Other




5                                    GAO/HEHS-97-126R         Uninsured Children and Immigration, 1995
ENCLOSURE II                                                                                  ENCLOSURE II
Figure 11.2: Percentage of Children Who Are Uninsured Within Each Birth and
Naturalization Status, 1995




    40
                                                                                            36.8




    30




    20

                            15.3                                        16

           12.5                                  12.1

    10




         U.S. Born   Native, Other Area   Native, Born Abroad   Naturalized Citizen   Foreign Noncitizen




6                                          GAO/HEHS-97-126R Uninsured Children and Immigration, 1995
ENCLOSURE II                                                                   ENCLOSURE II

Table II.1: Estimated Birth and Citizenship Status of All U.S. Children and Uninsured
Children. 1995


                               All U.S. children          Uninsured children
                               Number in       Percent    Number in        Percent
                               thousands                  thousands

 U.S. born                           66,213        95.2            8,250        89.3

 Native, Puerto Rico or U.S.             183        0.3               28         0.3
 outlying area
 Native, born abroad of U.S.            552         0.8               67         0.7
 parent
    Foreign-born naturalized            320         0.5               51         0.6
    citizen
    Foreign-born noncitizen            2,299        3.3              847         9.2

    Total                            69,568        100            9,243         100

Notes: Numbers or percents may not add due to rounding.

These estimates are based on parents' or other household members' report of children's
birth, citizenship, and health insurance status in the Mar. 1996 Current Population Survey.

The figures represent 98 percent of the estimated 71.148 million children aged 0 to 17
years old and 94 percent of the estimated 9.795 million uninsured children aged 0 to 17
years old and are based on those children in the sample whose records matched with the
record of a parent aged 18 to 64 years old or (in the absence of such a parent) other
relative aged 18 to 64 years old.




7                                     GAO/HEHS-97-126R    Uninsured Children and Immigration, 1995
ENCLOSURE III                                                                    ENCLOSURE III

'Table III.1: Estimated Birth and Citizenship Status of a Parent Who Matched With
Uninsured Children. 1995


                                  Number in thousands             Percent
    U.S. born                                             6,412                              69.4
    Native, Puerto Rico, or                                  83                               0.9
    U.S. outlying area
    Native, born abroad of U.S.                             100                                1.1
    parent
    Foreign-born naturalized                                551                               6.0
    citizen
    Foreign-born noncitizen                               2,097                              22.7
    Total                                                 9,243                              100

Notes: Numbers or percents may not add due to rounding.

These estimates are based on parents' or other household members' report of household
members' birth, and citizenship status, and children's health insurance status in the Mar.
1.996 Current Population Survey.

These figures represent a parent for 94 percent of the estimated 9.795 million uninsured
children aged 0 to 17 years old. They represent a parent for each of those uninsured
children whose records matched with the record of a parent aged 18 to 64 years old or
(in the absence of a parent) other relative aged 18 to 64 years old. Information is
reported on one parent (or other relative, in the absence of a parent) who matched with
each child-the first parent or relative who matched with the child.




8                                      GAO/HEHS-97-126R    Uninsured Children and Immigration, 1995
                              RELATED GAO PRODUCTS

Employment-Based Health Insurance: Costs Increase and Family Coverage Decreases
(GAO/HEHS-97-35, Feb. 24, 1997).

Children's Health Insurance 1995 (GAO/HEHS-97-68R, Feb. 19, 1997).

Children's Health Insurance Programs, 1996 (GAO/HEHS-97-40R, Dec. 3, 1996).

Medicaid and Uninsured Children, 1994 (GAO/HEHS-96-174R, July 9, 1996).

Health Insurance for Children: Private Insurance Coverage Continues to Deteriorate
(GAO/HEHS-96-129, June 17, 1996).

Health Insurance for Children: State and Private Programs Create New Strategies to
Insure Children (GAO/HEHS-96-35, Jan. 18, 1996).

Medicaid and Children's Insurance (GAO/HEHS-96-50R, Oct. 20, 1995).

Health Insurance for Children: Many Remain Uninsured Despite Medicaid Expansion
(GAO/HEHS-95-175, July 19, 1995).

Uninsured and Children on Medicaid (GAO/HEHS-95-83R, Feb. 14, 1995).




(101557)

9                                    GAO/HEHS-97-126R   Uninsured Children and Immigration, 1995