Adolescent Health Insurance Status: Analyses of Trends in Coverage and Preliminary Estimates of the Effects of an Employer Mandate and Medicaid Expansion on the Uninsured Page: 16
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16 * Preliminary Analyses of Adolescent Health
picture of the effects of living arrangement
on health insurance status emerges when fam-
ily income is taken into account. Part of the
reason why adolescents who do not live with
two parents are often uninsured is because
they are also likely to be poor. Most adoles
cents who live with only one parent live in or
near poverty: 60 percent of adolescents who
live with their mother only are in families
below 150 percent of poverty (table 4).
Adolescents who do not live with a parent at
all are even more likely to live in or near
poverty. In contrast, only 16.2 percent of
adolescents in two parent families live below
150 percent of poverty.
Almost half of poor or near poor adoles
cents who live with their mother only are in
sured under the Medicaid program (table 5).
In fact, this group of adolescents is more
likely than any others, even two parent fam-
ily dependents, to have health coverage. For
adolescents in families at 150 percent of
poverty or above, however, the expected re
lationship between living arrangement and in
surance status is found; those who live with
both parents are much more likely than
others to have health coverage.'Insurance Status
greater assets to protect and are thus likely to
be more risk averse than those with less edu
cation (and also more likely to be able to af-
ford to buy insurance); those with more edu
cation are likely to be valued more highly in
the labor market, thus, even controlling for
cash income we would expect their total com-
pensation to be greater; and those with more
education may be inclined to value the con
sumption of medical care more highly than
those with less education.
But to put the relative importance of ed
ucation in some perspective, in preliminary
multivariate analyses4it appears that, for
adolescents, low family income (i.e., below
150 percent of poverty) is a much stronger
predictor of being uninsured than having a
parent with limited education (i.e., less than a
high school education).
Parent's Work Status and Employment
Characteristics
Controlling for family income, adoles
cents who live with full time workers are
somewhat more likely than those living withParent's Education
The effects of parental education, even
controlling for family income, are quite
strong; at each income level, adolescents
whose parents have little formal education are
much more likely to be uninsured than
adolescents whose parents have had more ed
ucation (table 6).
The relatively strong relationship be
tween level of education and insurance status
may result from a number of factors: those
with more education are likely to have
3 This result is one of the only findings in this
section that is at variance with the findings from
the 1984 National Health Interview Survey (NH IS)
(Newacheck and McManus, 1989). Using the 1984
NH IS, Newacheck and McManus conclude that controll-
ing for family income there is no relationship be-
tween being in a single parent family and lack of
health insurance.4 Multivariate analyses were not well enough de-
veloped to report in full here. Correctly
specified analyses are a nontrivial problem. Al-
though limited dependent variable models can be
estimated with a 0-1 dependent variable measuring
whether or not an adolescent is insured, such
models do not correspond directly to any choices
being made. Rather, there is a hierarchical deci-
sion process. One way of specifying it is as fol-
lows: an adult either works at a job with health
benefits offered or not, and if so, decides whether
or not to cover any adolescent children. If no
benefits are offered, the children may or may not
be eligible for Medicaid, and if eligible, the
parent decides whether or not to apply. If there
is no employer-provided insurance and no public
program, then the parent decides whether or not to
buy nongroup insurance. Rather than one simple
model with a yeslno variable for insurance, at
least three models should be estimated (i.e.,
yeslno on employer provided insurance, Medicaid
eligibility/coverage, and purchase of nongroup in-
surance). It may be, of course, that reasonably
accurate estimates of the "effects" of independent
variables can be achieved from estimation of the
simple combined model, but this is not yet clear.
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United States. Congress. Office of Technology Assessment. Adolescent Health Insurance Status: Analyses of Trends in Coverage and Preliminary Estimates of the Effects of an Employer Mandate and Medicaid Expansion on the Uninsured, report, June 1989; [Washington D.C.]. (https://digital.library.unt.edu/ark:/67531/metadc39934/m1/21/: accessed April 19, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.