The Effects of Trigger Events on Changes in
Children's Health Insurance Coverage

By:
John L. Czajka
Cara Olsen

Mathematica Policy Research, Inc.
Washington, D.C.

April 18, 2000

Table of Contents

EXECUTIVE SUMMARY

• INTRODUCTION
• DATA AND METHODS
  1. Data
  2. Methodology
• FREQUENCY OF TRANSITIONS
  1. Transitions Between Types of Coverage
  2. Secondary Transitions
  3. Response Error
• CHANGES IN PARENTS' COVERAGE
• PRIOR EVENTS
  1. Types of Events
  2. Frequency of Prior Events
  3. Results by Type of Event
• EFFECTS OF TRIGGER EVENTS
  1. Regression Results
  2. Conditional Frequencies of Transitions
• DISCUSSION AND CONCLUSIONS

  APPENDIX TABLES

  REFERENCES

  TABLES

  1.     CHANGES IN CHILDREN'S HEALTH INSURANCE COVERAGE, JULY 1993 TO JUNE 1994

  2.     SAMPLE COUNTS AND POPULATION ESTIMATES OF SELECTED TRANSITIONS IN CHILDREN'S HEALTH INSURANCE COVERAGE: JULY 1993 TO JUNE 1994

  3.     OCCURRENCE OF A SECOND TRANSITION WITHIN FOUR MONTHS OF THE INITIAL TRANSITION

  4.     FREQUENCY WITH WHICH CHANGES IN RESPONDENT COINCIDED WITH REPORTED TRANSITIONS IN CHILDREN'S HEALTH INSURANCE COVERAGE

  5.     PERCENTAGE OF CHILDREN WHOSE PARENTS MADE THE SAME TRANSITION VERSUS OTHER OUTCOMES

  6.     CHILDREN MOVING FROM MEDICAID TO ESI: PARENTS' ESI COVERAGE BEFORE AND AFTER TRANSITION

  7.     AVERAGE MONTHLY NUMBER OF TRANSITIONS AND TRANSITION RATES, BY TYPE

  8.     FREQUENCY OF TRIGGER EVENTS AMONG CHILDREN WITH AND WITHOUT A TRANSITION, BY TYPE OF TRANSITION

  9.     NUMBER OF TRANSITIONS AND FREQUENCY OF TRIGGER EVENTS BY WHETHER TRANSITION WAS REVERSED AND TYPE OF TRANSITION

  10.     CHILDREN LOSING ESI VERSUS CHILDREN REMAINING COVERED BY ESI: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST MONTH

  11.     CHILDREN BECOMING INSURED VERSUS CHILDREN REMAINING UNINSURED: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST MONTH

  12.     CHILDREN LEAVING MEDICAID VERSUS CHILDREN REMAINING COVERED BY MEDICAID: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST MONTH

  13.     CHILDREN LEAVING OTHER INSURANCE VERSUS CHILDREN REMAINING COVERED: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST MONTH

  14.     LOGISTIC REGRESSION ESTIMATES OF THE EFFECTS (ODDS RATIOS) OF TRIGGER EVENTS ON THE ODDS OF CHILDREN LOSING ESI

  15.     LOGISTIC REGRESSION ESTIMATES OF THE EFFECTS (ODDS RATIOS) OF TRIGGER EVENTS ON THE ODDS OF UNINSURED CHILDREN BECOMING INSURED

  16.     LOGISTIC REGRESSION ESTIMATES OF THE EFFECTS (ODDS RATIOS) OF TRIGGER EVENTS ON THE ODDS OF CHILDREN LEAVING MEDICAID

  17.     LOGISTIC REGRESSION ESTIMATES OF THE EFFECTS (ODDS RATIOS) OF TRIGGER EVENTS ON THE ODDS OF CHILDREN LEAVING OTHER INSURANCE

  18.     CHILDREN WITH ESI WHO EXPERIENCED INDIVIDUAL EVENTS IN THE NEXT MONTH: PERCENTAGE DISTRIBUTION OF CHANGES IN COVERAGE IN THE NEXT FOUR MONTHS AND IMPLIED NUMBER OF TRANSITIONS

  19.     UNINSURED CHILDREN WHO EXPERIENCED INDIVIDUAL EVENTS IN THE NEXT MONTH: PERCENTAGE DISTRIBUTION OF CHANGES IN COVERAGE IN THE NEXT FOUR MONTHS AND IMPLIED NUMBER OF TRANSITIONS

  20.     CHILDREN WITH MEDICAID WHO EXPERIENCED INDIVIDUAL EVENTS IN THE NEXT MONTH: PERCENTAGE DISTRIBUTION OF CHANGES IN COVERAGE IN THE NEXT FOUR MONTHS AND IMPLIED NUMBER OF TRANSITIONS

  21.     CHILDREN WITH OTHER INSURANCE WHO EXPERIENCED INDIVIDUAL EVENTS IN THE NEXT MONTH: PERCENTAGE DISTRIBUTION OF CHANGES IN COVERAGE IN THE NEXT FOUR MONTHS AND IMPLIED NUMBER OF TRANSITIONS

  A.1     PERCENTAGE OF TRANSITIONS AND TRIGGER EVENTS REPORTED TO HAVE OCCURRED BETWEEN REFERENCE PERIODS

  A.2     CHILDREN LOSING ESI VERSUS CHILDREN REMAINING COVERED BY ESI: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST SIX MONTHS

  A.3     CHILDREN BECOMING INSURED VERSUS CHILDREN REMAINING UNINSURED: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST SIX MONTHS

  A.4    CHILDREN LEAVING MEDICAID VERSUS CHILDREN REMAINING COVERED BY MEDICAID: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST SIX MONTHS

  A.5    CHILDREN LEAVING OTHER INSURANCE VERSUS CHILDREN REMAINING COVERED: PERCENTAGE OF CHILDREN EXPERIENCING SELECTED EVENTS IN PAST SIX MONTHS

The work presented here has evolved considerably since its original inception. The authors are grateful to Robert Stewart and Sarah Goodell of ASPE for a very fruitful interaction over the length of the project. We want to thank Jim Verdier of MPR for reviewing earlier drafts of the material presented here, and we want to thank the members of the advisory committee for their helpful suggestions on the preceding draft. The advisory committee members were: Linda Bilheimer of the Congressional Budget Office and the Robert Wood Johnson Foundation; Paul Fronstin of the Employee Benefit Research Institute; John Holahan of The Urban Institute; Eugene Lewit of the Packard Foundation; and Katherine Swartz of the Harvard School of Public Health.

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