Health Insurance Coverage Rates Research Articles

Self-efficacy and health behaviors toward the prevention of diabetes among high risk individuals living in appalachia

Recent clinical trials indicate that type 2 diabetes can largely be prevented through lifestyle factors. In order to identify important modalities for the prevention of diabetes in medically underserved counties of Virginia (Appalachia), a questionnaire was administered to 135 at-risk individuals, having reported at least one risk factor for diabetes. The questionnaire assessed attitudes, self-efficacy, diet, and physical activity toward the prevention of type 2 diabetes. Overall, none of the respondents reported being told by a physician that they were at risk for diabetes. Overweight was the most frequently reported risk factor (87.0%), followed by physical inactivity (67.3%). More than one-third (38.9%) reported at least three diabetes symptoms. When stratified by low and high risk level, there were no significant differences in self-efficacy, control, and healthy dietary behaviors (p < .05). High risk individuals did report having lower rates of full health insurance coverage, being less active and running out of food more frequently than low risk individuals, however. The findings suggest that cost-effective prevention efforts should incorporate physician education, include screenings, and address self-efficacy enhancing strategies toward preventing type 2 diabetes.

Health Insurance and Health‐Care Utilization of U.S.‐Born Mexican‐American Children*

Objectives. We document and model health insurance coverage and health‐care utilization of very young, U.S.‐born Mexican‐American children relative to their non‐Hispanic white and black counterparts.Methods. We use data from the Fragile Families and Child Wellbeing Study and multivariate regression methods.Results. Based on descriptive and multivariate analyses, the findings show that compared to non‐Hispanic white children, Mexican‐American children have lower rates of health insurance coverage and less health‐care utilization. Mexican‐American children born in the United States to foreign‐born mothers utilize health care the least and are much more likely to be fully uninsured compared to other children.Conclusion. The early health advantage of Mexican‐origin children at birth runs the risk of being compromised by the time they reach age three as a result of poor access to healthcare. Greater health insurance coverage for Mexican‐American children and, in particular, Mexican‐American children of immigrants is needed.

The Impact of Public Insurance Expansions on Children’s Access and Use of Care

Our goal was to examine the impact of the State Children's Health Insurance Program nationally on children's access and use of health care. Our data source was the National Health Interview Survey, using 1997 as a baseline, which predates the implementation of the State Children's Health Insurance Program, and 2003 as the end point of the analysis. We analyzed 25,734 children aged 0 to 18 years (1997 and 2003 combined) to examine changes in health insurance coverage rates, health care access, and utilization for children in the State Children's Health Insurance Program target population, defined here as those living in families with incomes between 100% and 199% of the federal poverty level. Children in the State Children's Health Insurance Program target income group showed the largest reduction in rates of uninsurance among 3 income groups (< 100%, 100%-199%, and > or = 200% of the federal poverty level) between 1997 and 2003 (15.1%-8.7%). Significant reductions occurred in the proportion of children without a usual source of care in the target income group (9.4%-7.3%) and in the proportion of children without a provider visit in the past year (10.8%-9.8%). Other measures (unmet needs, delayed care, volume of provider visits, receipt of well-child care, and dental care) showed no significant changes over this time period. A separate multivariate analysis restricted to the State Children's Health Insurance Program target population in 2003 showed that children with continuous public coverage had significantly better access and utilization on all measures studied when compared with uninsured children and performed as well or better than children with continuous private coverage. Implementation of the State Children's Health Insurance Program is associated with substantial gains in public coverage for children in the target income group. Although some of these gains were offset by losses in private coverage, our findings demonstrate that public health insurance provides significant benefits in terms of access and utilization for children living in the target income group.

Unstable Inferences? An Examination of Complex Survey Sample Design Adjustments Using the Current Population Survey for Health Services Research

Statistical analysis of the Current Population Survey's Annual Social and Economic Supplement is used widely in health services research. However, the statistical evidence cited from the Current Population Survey (CPS) is not always consistent because researchers use a variety of methods to produce standard errors that are fundamental to significance tests. This analysis examines the 2002 Annual Social and Economic Supplement's (ASEC) estimates of national and state average income, national and state poverty rates, and national and state health insurance coverage rates. Findings show that the standard error estimates derived from the public use CPS data perform poorly compared with the survey design-based estimates derived from restricted internal data, and that the generalized variance parameters currently used by the U.S. Census Bureau in its ASEC reports and funding formula inputs perform erratically. Because the majority of published research (both by academics and Census Bureau analysts) does not make use of the survey design-based information available only on the internal ASEC data file, we argue that the Census Bureau ought to use alternative methods for its official ASEC reports. We also argue that for public use data the Census Bureau should produce a set of replicate weights for the ASEC or release a set of sample design variables that incorporate statistical "noise" to maintain respondent confidentiality (e.g., pseudo-primary sampling units) as other federal government surveys do. This is essential to make appropriate inferences using the ASEC data regarding statistical significance and estimate variance for health policy analysis.

Immigrants and employer-sponsored health insurance.

To investigate the factors underlying the lower rate of employer-sponsored health insurance coverage for foreign-born workers. 2001 Survey of Income and Program Participation. We estimate probit regressions to determine the effect of immigrant status on employer-sponsored health insurance coverage, including the probabilities of working for a firm that offers coverage, being eligible for coverage, and taking up coverage. We identified native born citizens, naturalized citizens, and noncitizen residents between the ages of 18 and 65, in the year 2002. First, we find that the large difference in coverage rates for immigrants and native-born Americans is driven by the very low rates of coverage for noncitizen immigrants. Differences between native-born and naturalized citizens are quite small and for some outcomes are statistically insignificant when we control for observable characteristics. Second, our results indicate that the gap between natives and noncitizens is explained mainly by differences in the probability of working for a firm that offers insurance. Conditional on working for such a firm, noncitizens are only slightly less likely to be eligible for coverage and, when eligible, are only slightly less likely to take up coverage. Third, roughly two-thirds of the native/noncitizen gap in coverage overall and in the probability of working for an insurance-providing employer is explained by characteristics of the individual and differences in the types of jobs they hold. The substantially higher rate of uninsurance among immigrants is driven by the lower rate of health insurance offers by the employers of immigrants.

Getting Started: Initiating Critical Ethnography and Community-Based Action Research in a Program of Rural Health Studies

Rural populations experience higher rates of illness, less access to health care resources, and lower rates of health insurance coverage than do urban populations. A need exists to identify and address the health care needs of rural communities and other isolated populations and to contextualize the findings in the larger rural health environment. Critical ethnography combined with community-based action research is a constructive approach for improving the health status of rural elders as well as other members of isolated communities. Detailed guidelines on how to initiate an ethnographic community-based action study, as shown through a study that explores the definitions of health, health care perceptions, and health care issues for rural elders in the southwestern United States, highlight the value of this type of research for the study of the health care issues of rural populations.

The Enigma of Higher Income Immigrants With Lower Rates of Health Insurance Coverage in the United States

This research compares rates of health insurance coverage among middle-class non-elderly immigrants to native-born American adults using data from the March 1996-2000 Supplements to the Current Population Survey. Probit regressions reveal that immigrants were three times as likely to be uninsured at income levels exceeding $50,000, controlling for economic, demographic and immigrant-related characteristics. Work-related characteristics, income, martial status and nativity considerably influenced health insurance status for all adults, but work-related factors had the strongest effect on immigrants' rates of coverage. Why, ceteris paribus, immigrants have lower coverage rates is unclear. Many low-income and recent immigrants face barriers to access due to legal status or job sector. But lower rates of health insurance coverage which persist among long-time residents at higher income levels cannot be explained by such barriers, a finding highly relevant for policy makers. Encouraging uninsured immigrants to opt into health plans voluntarily will remain a challenge.

Health Insurance Coverage in Survivors of Childhood Cancer: The Childhood Cancer Survivor Study

To examine the prevalence and predictors of health insurance coverage and the difficulties obtaining coverage in a large cohort of childhood cancer survivors. This study included 12,358 5-year survivors of childhood cancer and 3,553 sibling controls participating in the Childhood Cancer Survivor Study. Data were collected by surveys distributed in 1994 (baseline) and 2000 (follow-up). At baseline, 83.9% of adult survivors, compared with 88.3% of siblings, had health insurance coverage (P < .01); 6 years later, small but significant survivor-sibling differences remained (88% v 91%; P < .01). Twenty-nine percent of survivors reported having had difficulties obtaining coverage, compared with only 3% of siblings (P < .01). In multivariate analysis of survivors 18 years of age or older, factors associated with being uninsured included younger age at diagnosis (diagnosis age of 0 to 4 years; odds ratio [OR] = 1.7; 95% CI, 1.3 to 2.2), male sex (OR = 1.3; 95% CI, 1.2 to 1.5), age at baseline survey (age 22 to 24 years; OR = 1.6; 95% CI, 1.2 to 2.1), lower level of attained education (less than high school, OR = 2.6, 95% CI, 2.1 to 3.3; high school graduate, OR = 2.1, 95% CI, 1.8 to 2.5), income less than 20,000 dollars (OR = 5.6, 95% CI, 4.5 to 7.1), marital status (widowed/divorced/separated; OR = 1.3; 95% CI, 1.1 to 1.6), smoking status (current smoker, OR = 2.0, 95% CI, 1.7 to 2.3; former smoker, OR = 1.4, 95% CI, 1.2 to 1.8), and treatment that included cranial radiation (OR = 1.3, 95% CI, 1.0 to 1.6). Compared with siblings, adult survivors of childhood cancer had significantly lower rates of health insurance coverage and more difficulties obtaining coverage. Since lack of coverage likely has serious health and financial implications for this at-risk population, any disparity in availability and quality of coverage is of great concern.

Evaluating the Impact of the Earned Income Tax Credit on Health Insurance Coverage

The goals and design of the Earned Income Tax Credit suggest that it has the potential to affect private health insurance coverage rates in its target population through income, tax price and employment effects. Results from an analysis using data from the National Longitudinal Survey of Youth show that the EITC expansion of the mid-1990s did increase the rate of employer-based health insurance coverage in the low-skilled population. The overall effect of EITC expansions was to increase the probability of coverage by 3.8 percentage points, or approximately 375,000 more individuals who were covered by employer-provided policies between 1992 and 1998.

High Rates of Uninsured Among HCV-Positive Individuals

There are no published data on the health insurance status of Hepatitis C virus (HCV)-positive individuals. To address this issue, we analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III). Individuals 18 years of age and older who participated in NHANES III were included in the study. We determined the rates of health insurance coverage according to HCV status. We also determined healthcare status and health service utilization according to health insurance status among HCV-positive persons. HCV-positive individuals were more likely to be uninsured compared with those who were HCV-negative (29.6% vs. 12.2%, P = 0.0002). Among those with health insurance, HCV-positive individuals were more likely to have government insurance compared with those who were HCV-negative (42.9% vs. 27.6%, P < 0.005). Among HCV-positive individuals, being uninsured was associated with younger age, being unmarried, living in the South, Mexican-American race/ethnicity, and not graduating from high school. Additionally, the uninsured were less likely than their insured counterparts to identify a healthcare facility for sick or routine care, and less likely to have regular contact with a healthcare professional. A high proportion of HCV-positive individuals are uninsured, and many HCV-positive individuals with health insurance have publicly funded insurance. This finding may have implications for access to health care and for liver-related disease outcomes in HCV-positive persons.

Employment-Based Health Insurance: Analysis of Rural-Urban Differences in One State

This study estimates the propensity of firms to offer health insurance in a simultaneous equation model to control for the endogeneity between wages and health insurance. Previous research finds differences in rural and urban employer behavior with respect to health insurance benefits fully explained by differences in wages and firm size. In contrast, this study finds residual unexplained differences in the propensity to offer coverage that may be attributable to differences in plan supply, plan distribution, or differences in availability of substitutes for coverage (safety net care). Rural worker participation in offered coverage is more responsive to wage level than is the participation decision of urban workers. Together, these results imply that some of the differences in health insurance coverage rates for rural workers could be amenable to policy interventions.

EMPLOYMENT AND HEALTH INSURANCE COVERAGE FOR RURAL LATINO POPULATIONS

Rural Latino populations continue to grow in part due to relocation of food processing industries to rural America along with other manufacturing and large retail stores. We use data from the Current Population Survey to examine the labor force participation of rural Latino population and the role rural employers play in providing health insurance coverage. We found that while rural Latinos are more likely to be uninsured, the meat packing industry has higher health insurance coverage rates than other rural employers such as construction and retail. Local communities recruiting new businesses to their rural communities need to explore the role that employers will play in providing health insurance coverage. Lack of adequate coverage will have an impact on the income, resources, and day-to-day activities of physicians, hospitals and traditional safety net providers.

Population-Based Assessment of Diabetes Care and Self-management Among Puerto Rican Adults in New York City

The purpose of this study was to assess the status of diabetes medical care and self-management among adult Puerto Ricans in New York City. A random-digit-dialing telephone survey with a dual-frame sampling design was employed to obtain a probability sample of adult Puerto Ricans with diagnosed diabetes (n = 606). Demographic characteristics, health status, and indicators of diabetes medical care and self-management were collected using the standard Behavioral Risk Factor Surveillance System (BRFSS) questionnaire. A statewide sample of adults with diagnosed diabetes (n = 232) was obtained from the BRFSS for comparison. Compared to New York State adults, Puerto Ricans were significantly less likely to receive annual A1C testing (72.7% vs 84.9%), cholesterol testing (67.5% vs 87.2%), blood-pressure-lowering medication (82.4% vs 91.9%), and pneumococcal vaccination (19.3% vs 28.5%, among those aged 18 to 64 years). Puerto Ricans were also less likely to take aspirin every day or every other day to prevent cardiovascular complications (30.6% vs 40.7%). Puerto Ricans were younger and more likely to have lower educational attainment and lower income than New York State adults, but they were not significantly disadvantaged in access to health care indicated by rates of health insurance coverage, having a particular place for medical care, and frequencies of seeing a provider for diabetes. These findings support the need to introduce culturally sensitive and linguistically appropriate diabetes education programs for Puerto Ricans and continue system-based diabetes care quality improvement efforts in the areas of prevention and control of cardiovascular complications, adult immunization, and A1C testing.

Race/Ethnic Disparities in Utilization of Lifesaving Technologies by Medicare Ischemic Heart Disease Beneficiaries

The objective of this study was to explain race/ethnic disparities in hospitalizations, utilization of high-technology diagnostic and revascularization services, and mortality of elderly ischemic heart disease (IHD) patients. A longitudinal Medicare claims database of all Part A hospital and Part B physician services provided elderly patients admitted for IHD in 1997 is used to construct admission, utilization, and mortality rates for whites and blacks, Asians, Hispanics, and American Indians. Z-scores are used to test differences in rates between whites and minorities at the 99% confidence level. Logistic and proportional hazard models are used to predict the likelihood of revascularization and its effects on race/ethnic survival 2 years postdischarge. The setting of this study was an acute hospital supplemented by all ambulatory Part B outpatient providers of care. Participants included all 700,000 age 65+ Medicare beneficiaries in fee-for-service identified with IHD as a primary diagnosis on admission in 1997. Whites were 26% more likely to be admitted for IHD than blacks, 50% more likely than Asians, 5% more than American Indians, but 3% less likely than Hispanics. Once admitted, elderly blacks and American Indians undergo invasive diagnostic and surgical revascularization far less often than whites (P < 0.01), although blacks are equally as likely as whites to be admitted to an open heart hospital. Controlling for other factors, whites reduce their 2-year mortality by 20% by undergoing revascularization 41% of the time. Blacks gain only 11% as a result of much lower rates and gains to revascularization than whites. Asians and Hispanics were slightly more likely than whites to undergo revascularization but gain less than whites from the procedure. Despite having similar Medicare health insurance coverage, elderly utilization and IHD mortality rates differ markedly not only between whites and minorities, but within minority groups themselves. A large, nationally representative survey of physicians and patients is needed to distinguish between systemwide "failures to refer" and patient "aversions to surgery" as explanations for lower black rates of surgical interventions.

Healthcare Coverage for Children: Are We Making Progress?

Residents| April 01 2005 Healthcare Coverage for Children: Are We Making Progress? AAP Grand Rounds (2005) 13 (4): 46. https://doi.org/10.1542/gr.13-4-46 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Healthcare Coverage for Children: Are We Making Progress?. AAP Grand Rounds April 2005; 13 (4): 46. https://doi.org/10.1542/gr.13-4-46 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: children's health insurance program (chip), healthcare payer, immunization, income, insurance, insurance coverage, medicaid, medical home, medical insurance coverage, poverty Source: Blewett L, Davern M, Rodin H. Covering kids: variation in health insurance coverage trends by state, 1996–2002. Health Affairs. 2004;23:170–180. To better understand the impact of state efforts to increase enrollment of children in public programs, investigators from the University of Minnesota, Minneapolis, estimated state-specific changes in health insurance coverage rates for children between 1996–1998 and 2001–2002. The analysis was performed using data from the Current Population Survey Demographic Supplement (CPS-DS), a survey conducted annually by the United States Census Bureau. Differences in rates of insured children and types of insurance were compared between the 2 time periods. Using a multinomial logistic regression model, and subsequent recycled probabilities methodology, investigators looked at specific family and child characteristics associated with change in health insurance coverage. Between 1996–1998 and 2001–2002 there was a decrease in the percentage of uninsured children in 27 states, and an increase in the number of children enrolled in public insurance in 29 states (P<.05 to <.001). Nationally, there was a significant increase in the number of children with public health insurance. There was no significant change in children receiving private coverage. It was estimated that 12.7% of US children were uninsured in the period 2001–2002; using adjusted analyses, this was not significantly different from the rate in 1996–1998. Analyses showed that children living in homes with incomes below 200 percent of poverty had the largest increase in public program coverage (P<.05). A decrease in the percentage of uninsured children was seen with incomes below 100 percent of poverty (P<.01), but not for incomes of 100–199% of poverty. Dr. Hargunani has disclosed no financial relationships relevant to this commentary. Over the past 10 years, major efforts have been made to decrease the numbers of uninsured children in the US. However, many states have been faced with funding cuts and SCHIP enrollment freezes leading to increased premiums and/or enrollment caps. Insurance coverage is directly correlated with improved access to healthcare, improved immunization rates, and decreased ED utilization.1–,4 While this article gives us hope that public program coverage is on the rise and uninsured rates are decreasing in some states, the results do not provide insights into which specific efforts or challenges have affected these rates. In addition, these data do not help us to predict future insurance coverage rates given the current fiscal environment. As practicing pediatricians, we need to advocate for improved insurance coverage and support legislative efforts to ensure steady improvements in children’s healthcare. While these trends are encouraging, until such time as Medicaid reimbursement is comparable to that of other payers, Medicaid coverage will not assure access to a medical home for all children. You do not currently have access to this content.

Covering Kids: Variation In Health Insurance Coverage Trends By State, 1996–2002

We estimated state-specific changes in health insurance coverage rates for children between 1996-1998 and 2001-2002. We found considerable variation in the changing distribution of health insurance coverage for children across states, with significant increases in public program coverage in twenty-nine states and significant decreases in uninsured children in twenty-seven. Children in families with incomes below 200 percent of the federal poverty level were the most likely to enroll in public programs. We provide an overview of state outreach and administrative simplification efforts and raise concerns about the persistent variation in children's health insurance coverage across states.

Welfare reform, labor supply, and health insurance in the immigrant population

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.

Extended follow-up of long-term survivors of childhood acute lymphoblastic leukemia.

Children who survive acute lymphoblastic leukemia are at risk for leukemia-related or treatment-related complications, which can adversely affect survival and socioeconomic status. We determined the long-term survival and the rates of health insurance coverage, marriage, and employment among patients who had attained at least 10 years of event-free survival. A total of 856 eligible patients were treated between 1962 and 1992 in 13 consecutive clinical trials. Survival rates, the cumulative risk of a second neoplasm, and selected indicators of socioeconomic status were analyzed for the entire group and for patients who did or did not receive cranial or craniospinal radiation therapy during initial treatment. Fifty-six patients had major adverse events, including 8 deaths during remission, 4 relapses, and 44 second neoplasms (41 of them radiation-related); most of the second neoplasms were benign or of a low grade of malignant potential. The risk of a second neoplasm was significantly higher in the 597 patients who received radiation therapy (irradiated group) than in the 259 patients who did not receive radiation therapy (nonirradiated group) (P=0.04; estimated cumulative risk [+/-SE] at 20 years, 20.9+/-3.9 percent vs. 0.95+/-0.9 percent). The death rate for the irradiated group slightly exceeded the expected rate in the general U.S. population (standardized mortality ratio, 1.90; 95 percent confidence interval, 1.12 to 3.00), whereas that for the nonirradiated group did not differ from the population norm (standardized mortality ratio, 1.75; 95 percent confidence interval, 0.34 to 5.00). The rates of health insurance coverage, marriage, and employment in the nonirradiated group were similar to the age- and sex-adjusted national averages. Despite having health insurance rates similar to those in the general population, men and women in the irradiated group had higher-than-average unemployment rates (15.1 percent vs. 5.4 percent and 35.4 percent vs. 5.2 percent, respectively), and women in the irradiated group were less likely to be married (35.2 percent vs. 48.8 percent). Children with acute lymphoblastic leukemia who did not receive radiation therapy and who have attained 10 or more years of event-free survival can expect a normal long-term survival. Irradiation is associated with the development of second neoplasms, a slight excess in mortality, and an increased unemployment rate.

Care of Children with Special Health Care Needs

One measure of a society's goodness is how well it cares for its children. This standard has particular importance for vulnerable groups of children, such as those facing health challenges. Thus, the level of care that children with receive through public programs could be seen as a critical marker of the success of the nation's publicly funded health insurance programs. This article reviews the characteristics of children with health care needs, the types of publicly funded programs that serve them, and the challenges and opportunities involved with providing them with quality health care. It concludes by offering suggestions for improvement, such as enhancing outreach strategies and fostering collaboration across programs. Who Are Children with Special Health Care Needs? The term special health care needs (SHCNs) has been defined in a number of ways. In general, the children in this category tend to have a high need for services with correspondingly high health care costs. They also rely heavily on care and ancillary services. In addition, they are especially vulnerable to adverse health outcomes. (See Profile of Children with Special Health Care Needs for a profile of this group of children.) To plan and evaluate health care coverage for children with SHCNs, policymakers and administrators require information about the size and of this population. Yet, no uniformity exists in the way different states or programs identify children with SHCNs. Box 1 Profile of Children with Special Health Care Needs * Prevalence by Demographic Characteristics: Compared with other children, children with SHCNs are more likely to be over age three, white, and living with parents with low incomes and educational levels. * Burden of Illness: Children with SHCNs have poorer health status and more days in bed or absences from school than other children. The burden upon some families is enormous. * Access to Services: Compared with other children, children with SHCNs seem to have similar rates of health insurance coverage and similar rates of having a usual source of care. (a) However, children with SHCNs have higher rates of unmet health care needs. * Use of Services: Children with SHCNs use more outpatient, inpatient, pharmacy, and ancillary services than other children; some use extremely intensive services. * Special Services: The range of services needed by children with SHCNs varies widely, with many requiring high-technology care, highly specialized services, and extensive ancillary (wraparound) services. * Co-Morbidities: Many children with SHCNs have more than one chronic health problem, and many also have developmental, behavioral, and social problems. * Costs: Because children with SHCNs tend to use services more, the cost of caring for these children is higher than for the general population of children; however, the distribution of costs across types of services varies widely with the diagnosis and severity of illness. * Burden of Cost: Families with children having SHCNs often spend a considerable amount of their own income (as much as 9% to 12%) for expenses not covered by insurance, (b) and they may use up an insurance policy's lifetime limit on benefits. (5) (a) Having a usual source of care is not the same as having a medical home, but it is a first step (see Box 3). (b) Leonard, B., Buret, J.D., and Sapianza, J.J. Financial and time coots to parents of severely disabled children. Public Health Reports (1992) 107:302-12. (c) Edmunds, M., and Coye, M.J., eds. America's children. Washington, DC: National Academy Press, 1998. Sources: Stein, R.E.K., and Silver, E.J. Operationalizing a conceptually based noncategorical definition: A first look at US children with chronic conditions, Archives of Pediatrics and Adolescent Medicine (1999) 153:68-74; Newacheck, P.W., Strickland, B., Shonkoff, J. …

The Impact of Macroeconomic Conditions on the Health Insurance Coverage of Americans

In March 2001, the longest economic expansion in U.S. history ended, and an economic recession began. This paper seeks to provide a better understanding of the historical relationship between macroeconomic variables and health insurance coverage.We use data from two nationally representative samples: the Survey of Income and Program Participation (SIPP) and the National Longitudinal Survey of Youth (NLSY). The longitudinal nature of our data allows us to remove individual-specific, time-invariant heterogeneity and to focus on changes in health insurance status in response to changes in macroeconomic variables.The results confirm our prediction that the probability of any health insurance coverage is negatively associated with unemployment rate. We find that a one percentage point increase in the state unemployment rate is associated with a decrease in the probability of health insurance coverage, through any source, of 0.62 percent for men, 0.54 percent for women, and 1.1 percent for children. However, our prediction that an indicator variable for national recession would be negatively correlated with the probability of health insurance coverage is not supported by the data. We find that changes in employment status explain roughly one-quarter of the correlation between health insurance coverage and unemployment rates. Our estimates imply that 440,000 men, 436,000 women, and 494,000 children have lost health insurance coverage during the current recession.