oversight

Children's Health Insurance 1995

Published by the Government Accountability Office on 1997-02-19.

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

       United States
GAO    General Accounting Office
       Washington, D.C. 20648

       Health, Education and Human Services Division



      B-276046
      February 19, 1997
      The Honorable JamesM. Jeffords
      ChaIrman, Committee on Labor and Human Resources
      United States Senate
      Dear Senator Jeffordsz
      Since 1987,the number of children under 18 years of age who lack health
      insurance has increased. To help the Committee better understand recent
      trends iu children’s health insurance through 1996,you asked us to prepare a
      series of figures and tables-some of which update information that we provided
      to the Committee or the Subcommittee on Children and Families in previous
      reports and correspondence (see enclosufe III for list of previous work). In
      addition, you asked for a set of tables showing the number and percentage of
      uninsured children, 0 to 17 years of age, and uninsured young adults, 18 to 20
      years of age, by different ages and poverty levels’ in 1996.

      To develop this information, we used data from the March 1996Current
      Population Survey, which includes insurance coverage during 1996. Our work
      was conducted during January and February 1997in accordance with generally
      accepted government auditing standards.
      In summary, we found that health insurance coverage for children appeared to
      stabilize in 1996,after declining between 1987and 1994. In 1996,young adults
      were less likely to have health insurance coverage than children. Over 23
      percent of those aged 18 to 20 are uninsured in 1996,compared with 13.8
      percent for all children under 18. (Enclosures I and II provide details, some of
      which are highEghted below.)




      ‘The Federal Poverty Income Guidelines set the federal poverty level according
      to family size and income. In 1996,a family of three with annual income of
      $12,980or less would have an income at or below 100 percent of the federal
      poverty level and would be considered poor.
                                    GAO/HEXS-97-68RChildren’s Health Insurance 1996
B-276046                                                    .

CHILDREN WITH PRIVATE INSURANCEOR MEDICAID

Between 1987 and 1994,the percentageof children with p&&e health
insurance decreased and the number and percentage of children with Medicaid
rose substantially (see enclosure X,table 1.1 and figs. 1.1-1.3). Between 1994and
 1996,the percentage of children with private health insurance and the
percentage of children with Medicaid increased,but neither was a stat&tic&y
significant change.
UNINSURED CHILDREN
The percentage of uninsured children under 18 increased only slightly between
 1987and 1996 (see fig. 1.4). One reason the increase was not greater, given the
drop in private coverage, was that Medicaid eligibility expansions enabledmore
low-income children to enroll in Medicaid. But the number of uninsured
children rose substantially-from 8.2 million children to 9.8 million children-
coinciding with a rise in the number of children under 18 in the United States
(see table I.1 and fig. 1.6). Between 1994and 1996,the number and percentage
of uninsured children decreased,but the change was not stat&t&ally significanL
The percentage of uninsured children under 18 varies by poverty level (see
enclosure II, tables Xl-II.3). In 1996, 39 percent of &nsured children under
18 were poor and 78 percent were in families with income at or below 226
percent of the federal poverty level.
UNINSURED YOUNG ADULTS. AGED 18 TO 20

In 1996,the percentage of uninsured young adults, 18 to 20 years of age,who
were poor (39 percent) or had income at or below 226 percent of the federal
poverty level (73 percent) was similar to the percentage of uninsured children
at those income levels (see enclosure II, table lI.6). A higher percentageof
young adults, 18 to 20 years of age, are uninsured (23 percent) than are
children under 18 (see table H-7).
Becausethis work was largely developedusing data and procedures used in
previous GAO reports listed in enclosureIII., we did not seek agencycomments
on a draft of this correspondence.




                            GAODIEHS-97-&3RChildren’s Health Insurance 1996
    B-276045



    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 Benin

    Sincerely yours,



v   Jonathan Ratner
    Associate Director, Health Financing and Systems Issues

    Enclosures




                              GAO/HEHS-97-6SR Children’s Health Insurance 1995
ENCLOSURE I                                                                       ENCLOSURE I


                        TABLE AND FIGURES WITH TRENDS
                IN CHILDREN’S WEALTH INSURANCE STATUS. 1987-95


Table 1.1: Health Insurance Status of ChiIdren Under 18.1987-95

Numbers in thousands

    Year      I Private insurance          I Medicaid               I Uninsured




    1990          46,436            71.1         12,094      18.5        8,504        13.0
    1989          47,376            73.6         10,100      15.7        8,548        13.3
    1988          46,944            73.6          9,961      15.6         8,350       13.1
    1987          46,763            73.6          9,681      15.2         8,193       12.9

Note: Rows may add to more than 100 percent because children with both private
insurance and Medicaid wiII be counted in both categories. In any year, less than5
percent of children have insurance other than private insurance or Medicaid, such as
CHAMPUS, and they are not included in this table.

Changes in the data coIIection method, sample frame, or population weights can change
estimates and make them less than completely comparable with previous years’ estimates.

“Data collection method changed to entirely computer-assisted telephone interviewing and
sample frame partially changed. Estimates between 1993 and 1994 may not therefore be
entirely comparable.




4                                          GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE I                                                                ENCLOSURE 1

bData collection method partially changed to computer-assisted telephone interviewing.
Estimates between 1992 and 1993 may not be entirely comparable.

c~mplementation of 1990 census population weights.

Source: The Bureau of the Census.




                                    GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE I                                                                                                 ENCLOSURE I
Figure 1.1: Percentage of Adults and Children With Private Health Insurance. 1987-95



80r

75
      .....    ..“...................      ..........




70


                                                                                         I...-..........-   ...

65-


60 -                                  I              1      I      I       I       I          I               I
 1987                               1988           1989   1990   1991    1992    1993       1994            1995


-             Adults t 8-64
---sm. Children Under 18




6                                                                GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE I                                                               ENCLOSURE I

Figure 1.2: Percentage of Children Enrolled in Medicaid. 1987-95




25




20 -




15 --




           I       I       I        I      I       I       I         I
10 ’
 t 987   1988    1989    1990    t 991   1992    1993    1994      1995




                                    GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE I                                                              ENCLOSURE I
Figure 1.3: Number of Children Under 18 Enrolled in Medicaid, 1987-95

In millions




  20

        c


  15 -




  10 -_       9.7




   5.




    0
            1987    1988   1989   1990    1991    1992    1993    1994    1995




                                     GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE I                                                                                                                                  ENCLOSURE I
Figure 1.4: Percentage of Uninsured Adults and Children. 1987-95




20 -



                                                                                                        *****........----..........
       ***_.............------------------~..........”......********~*...........--          *....---


10 -



 5-



 0                   I                 I                 I                I             I             I                   I             1
 1987              1988              1989              1990             1991          1992          1993                1994          1995

-     Adults 18-W
----- Children Under 18




9                                                                               GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE II                                                                ENCLOSURE II


                      TABLES WITH CHILDREN’S AND YOUNG ADULTS’
               HEALTH INSURANCE STATUS, BY AGE AND POVERTY LEVELS. 1995


Table 11.1:Number of Uninsured Children Aned 0 to 17 Years. bv Povem Levels. 1995

In thousands




Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




11                                     GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE II                                                                    ENCLOSURE


Table 11.2:Percentage of Uninsured Children. Aged 0 to 17 Years. bv Povertv Levels. 1995



                Percent of federal poverty level
    Age         O-100      101-133    134185       186-225    226-300    Over 306   Total
    O-5         34.6       29.8       31.6         32.6       34.2       34.1       33.2
    6-12        37.3       41.3       41.4         39.2       36.4       35.9       38.4
    13-17       28.1       28.8       27.0         28.2       29.4       30.0       28.4
    Total       100        100        100          100        100        100        100

Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




Table 11.3:Percentage of Uninsured Children, Aged 0 to 17. bv Povertv Levels Within Age
Groum, 1995


                                                                                               I
                Percent of federal poverty level
    Age group   6-100      101-133     134185      186225     226-300    Over 300   Total      i
    O-5         41.1       12.0        15.7        8.6        9.9        12.7       100        ;
    6-12        38.2       14.4        17.8        8.9        9.2        11.5       100        f
    13-17       39.1       13.6        15.7        8.7        10.0       13.0       100        i.
~
# Total         39.4       13.4        16.5        8.7        9.7        12.3       100        f

Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.



12                                          GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE II                                                                  ENCLOSURE II

Table II.4: Number of Uninsured Young Adults. Aged 18 to 20. bv Povertv Levels. 1995

In thousands




u 20           379       85         103        96           116        155         934
               976       256        332        261          246        417         2,487
/ Total

Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




13                                    GAO/HEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE II                                                                        ENCLOSLRE I:

Table 11.5:Percentage of Uninsured Young Adults. Aged 18 to 20. bv Povertv Levels. 1995




Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




Table 11.6:Percentage of Uninsured Young Adults. Aged 18 to 20. bv Povertv Levels Within Age
Grows. 1995



             IIPercent of federal   poverty level

 Age                    I 101-133 I 134185          I 186-225   I 226300   1 Over 300 I Total
 18            38.7       11.7         15.0          10.4        9.2        14.9        100
 19            38.2       10.4         14.5          10.8        7.6        18.5        100
 20            40.6       9.1          11.0          10.3        12.4       16.6        100
 Total         39.2     I 10.3        I 13.4        I 10.5      I 9.9      I 16.8      I 100
Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




14                                         GAOHEHS-97-68R Children’s Health Insurance 1995
ENCLOSURE II                                                                      ENCLOSURE II
Table 11.7:Percentage of All Young Adults. Aged 18 to 20. Who Are Uninsured. bv Povertv
Levels. 1995



               Percent of federal poverty level

     k.ge
     18
     19
     20
     Total

Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




15                                      GAOIHEHS-97433R     Children’s Health Insurance   1995
ENCLOSURE II                                                                    ENCLOSURE II
Table 11.8:Number and Percentage of Uninsured Children. Under 1 Year. bv Povertv Levels. 1995

Numbers in thousands



               Percent of federaI poverty level
               O-100    1 101-133 1 134185        186225    1 226-300   1 Over 300 1 Total
 Number        232        83        I 84          57         66          129         653
 Percent by                                       8.8        10.1        19.8        100
 poverty
 level
 Percent                                          20         14.2        10.2        16.7
 WninSUred


Note: Numbers may not add due to rounding.

Source: Analysis of March 1996 Current Population Survey.




16                                         GAOLHEHS-97-68R Children’s Health hsurance 1995
ENCLOSURE III                                                 ENCLOSURE III


                         RELATED GAO PRODUCTS

Children’s Health Insurance Programs, 1996 (GAO/HEHS974OR, Dec. 3, 1996).

Medicaid and Uninsured Children. 1994 (GAO/HEHS96174R, JuIy 9, 1996).

Health Insurance for Children: Private Insurance Coverage Continues to
Deteriorate (GAOBIEHS-96129, June 17, 1996).

Health Insurance for Children: State and Private Programs Create New
Strategies to Insure Children (GAO/HEHS-96$5, Jan. 18, 1996).

Medicaid and Children’s Jnsurance (GAO/HEHS-9650R, Oct. 20, 1995).

Health Insurance for Children: Manv Remain Uninsured Despite Medicaid
Expansion (GAO/HEHS-95175, July 19, 1995).

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




(101539)



17                        GAOIHEHS-97-68R Children’s Health Insurance 1995
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