Stability of children’s insurance coverage and implications for access to care: Evidence from the Survey of Income and Program Participation

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Even as the number of children with health insurance has increased, coverage transitions—movement into and out of coverage and between public and private insurance— have become more common. Drawing on HCFO-funded work, this article examines whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, the researchers estimate the relationship between insurance and the probability that a child has at least one physician visit per year. The researchers found a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor’s visit than children who are uninsured for a full year, but less likely than children with full-year coverage. The researchers found comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when the researchers conditioned on child fixed effects.

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