1. Entrances and Exits: Health Insurance Churning 1998-2000 Sherry Glied, PhD Kathryn Klein, BA Danielle Ferry, BA Supported by a grant from The Commonwealth Fund

2. 2 Transitions interfere with care seeking Transitions affect take-up of coverage Transitions affect crowd-out of coverage

3. 3 Prior Studies on Churning 1996 panel of the Survey of Income and Program Participation (SIPP) Over 4 years: –32.1 percent of the population – 84.8 million people -- lacked health insurance for at least 1 month –45 million uninsured at a point in time

4. 4 This Study Uses MEPS 1998-2000 –Population <62 (includes kids) –One month or longer gap 3 goals of this study: –describe demographic characteristics of those at risk for churning –understand how type of coverage affects insurance stability –understand how demographics and coverage type interact

5. 5 Nearly One in Three <62 Experienced a Spell of Uninsurance During a Two-Year Period, 1998-2000 Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS). Always insured, 69% One or more spells of uninsurance, 22% Always uninsured, 9%

6. 6 Minorities Are Especially Likely to Experience Insurance Instability * During the two-year study period, 1998-2000 Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS).

7. 7 Those with Income Under 200% Poverty Are Less Likely to Have Stable Insurance Coverage * During the two-year study period, 1998-2000 Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS).

8. 8 Age and Spells of Uninsurance Kids <17 – least likely to be continuously uninsured (5%) Adults 53-64 – most likely to be continuously insured (82%) Adults 17-22 – most likely to be continuously uninsured and to have gaps in coverage –Just ½ continuously insured

9. 9 Results - Spells Young adults, low income, Hispanics, less educated at highest risk of spell Kids least likely to be continuously uninsured

10. 10 Initial Insurance Type and Insurance Stability Initial insurance status: Proportion of population Retained initial insurance status One or more spells of uninsurance Other transition Uninsured19%49%51%0% Medicaid10%61%30%10% Private group insurance 65%86%12%2% Private non- group insurance 5%53%21%26% Other2%49%14%37% Total Sample Size: 19,187 people for 2 yrs of observation. Total of 460,488 person months of observation. Note: About 60% of new entrants to non-group were previously uninsured Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS).

11. 11 Insurance Status and Insurance Stability Among Those Who Were Low-Income* Throughout the Study Period * Under 200% poverty Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS). Retained initial insurance status Other transition One or more spells of uninsurance Medicaid UninsuredPrivate group insurance

12. 12 Insurance Status and Insurance Stability Among Those Who Were Low-Income* in Year 1 * Under 200% poverty Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS). Retained initial insurance status Other transition One or more spells of uninsurance Medicaid UninsuredPrivate group insurance

13. 13 Insurance Status and Insurance Stability Among Those Who Were Never Low-Income* * Under 200% poverty Source: Author’s Analysis of the 1998-2000 Medical Expenditure Panel Survey (MEPS). Retained initial insurance status Other transition One or more spells of uninsurance Medicaid UninsuredPrivate group insurance

14. 14 Results – Retaining Coverage About ½ of those who begin with non-group transition out of it within 2 years –½ have a spell of uninsurance Low income people, Hispanics, and young adults who begin with private group likely to have a spell of uninsurance –Between 1/5 and 1/3 Substantial instability for those who begin with Medicaid –Over ¼, even among kids, have at least one spell of uninsurance

15. 15 Conclusions Having insurance ≠ keeping insurance Groups with difficulty getting coverage have difficulty keeping it Private group generally most stable (except among continuously low income)