Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004-2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of nonelderly Americans) were uninsured for at least 1 month during those 4 years. Approximately 23 million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms’ effects on coverage stability.
BachrachD.BoozangP.DuttonM. (2011). Medicaid’s role in the health benefits exchange: A road map for states. Washington, DC: National Academy for State Health Policy.
2.
BhandariS.MillsR. (2003). Dynamics of economic well-being: Health insurance 1996-1999 (Current Population Reports, P-70-92). Washington, DC: U.S. Census Bureau.
3.
CohenR. A.MakucD. M.BernsteinA. B.BilheimerL. T.Powell-GrinerE. (2009). Health insurance coverage trends, 1959-2007: Estimates from the National Health Interview Survey (National Health Statistics Reports; No. 17). Hyattsville, MD: National Center for Health Statistics.
4.
Congressional Budget Office. (2003). How many people lack health insurance and for how long? Retrieved from http://www.cbo.gov/publication/14426
5.
Congressional Budget Office. (2011). CBO’s analysis of the major health care legislation enacted in March 2010. Statement of Douglas W. Elmendorf, Director, before the Subcommittee on Health Committee on Energy and Commerce, U.S. House of Representatives, March30, 2011. Retrieved from http://www.cbo.gov/ftpdocs/121xx/doc12119/03-30-HealthCareLegislation.pdf
6.
CutlerD. M.GelberA. M. (2009). Changes in the incidence and duration of periods without insurance. New England Journal of Medicine, 360, 1740-1748.
7.
HillH. D.ShaeferH. L. (2011). Covered today, sick tomorrow? Trends and correlates of children’s health insurance instability. Medicare Care Research and Review, 68, 523-536.
8.
LovelessT. A.TinJ. (2006). Dynamics of economic well-being: Participation in government assistance programs 2001-2003, Who gets assistance? (Current Population Reports, P-70-108). Washington, DC: U.S. Census Bureau.
9.
National Research Council. (2009). Reengineering the Survey of Income and Program Participation (Panel on the Census Bureau’s Reengineered Survey of Income and Program Participation, Constance F. Citro & John Karl Scholz, Editors. Committee on National Statistics, Division of Behavioral and Social Sciences and Education). Washington, DC: National Academies Press.
10.
ShortP. F.GraefeD. R. (2003). Battery-powered health insurance? Stability in coverage of the uninsured. Health Affairs, 22, 244-255.
SommersB.RosenbaumS. (2011). Issues in health reforms: How changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health Affairs, 30, 228-236.
13.
SwartzK. (1994). Dynamics of people without health insurance: Don’t let the numbers fool you. Journal of the American Medical Association, 271, 64-66.
14.
SwartzK.MarcotteJ.McBrideT. D. (1993). Personal characteristics and spells without health insurance. Inquiry, 30, 64-76.
15.
SwartzK.McBrideT. D. (1990). Spells without health insurance: Distributions of durations and their link to point-in-time estimates of the uninsured. Inquiry, 27, 281-288.
