The independent source for health policy research, polling, and news.
A summary and toplines from a national survey conducted for the Foundation by Market Facts, Inc. of public knowledge about STDs overall and their attitudes towards policy options to confront the spread of STDs. This survey was released at a briefing on Sexually Transmitted Diseases: Exposing the Epidemic.
The Kaiser Survey on Public Knowledge and Attitudes about STDs other than AIDS
Questionnaire and Toplines
November 20, 1996
Conducted for The Henry J. Kaiser Family Foundation by Market Facts, Inc.
Number of Interviews: 707 men and women ages 18-64 Margin of Error: plus or minus 4 percentage points Dates of Interviewing: November 8-10, 1996
1. Can you tell me the names of any sexually transmitted diseases or S.T.D.s, which also used to be called V.D. or venereal diseases? (Probe once:) What others can you name? (Do not read list. Enter all that apply.)
Gonorrhea 68% AIDS or HIV or human immunodeficiency virus 60% Syphilis 53% Herpes or genital herpes or herpes simplex virus or HSV 37% Chlamydia 24% Warts or genital warts or human papilloma viruses or HPVs 7% HBV or Hepatitis-B virus 4% Pubic lice 4% Crabs 3% Trich or trichomoniasis 2% BV or bacterial vaginosis 1% Chancroid 1% Other 4% None 7% Don’t know 4% Refused/No answer 1%
As you may know, HIV or AIDS is one of the most serious sexually transmitted diseases. Now I am going to ask you a few questions about sexually transmitted diseases OTHER than HIV or AIDS.
2. To the best of your knowledge are there ways that sexually active people can avoid getting sexually transmitted diseases?
Yes 93% No 6% Don’t know 1% Refused/No answer *
3. To the best of your knowledge, are all sexually transmitted diseases curable?
Yes 17% No 80% Don’t know 3% Refused *
4. Of every 100 people in this country, how many do you think will become infected with a sexually transmitted disease at some point in their lives? Just give me your best guess by responding with any number between 1 and 100 (Enter number from 1 to 100. Do not accept a range.)
1-10 16% 11-20 12% 21-30 16% 31-40 7% 41-50 20% 51-60 6% 61-70 4% 71-80 11% 81-90 4% 91-100 3% Don’t know 11% Mean answer given: 42% Percent responding with correct answer (21 to 30): 16%
5. Do you know anyone who has had a sexually transmitted disease? Again we are asking about sexually transmitted diseases other than HIV or AIDS.
Yes 45% No 54% Don’t know * Refused * 6. Do you think the number of people getting infected with sexually transmitted diseases has gone up, gone down or stayed about the same over the last 10 years? (Do not read list. Enter only one response.)
Gone up 72% Stayed about the same 17% Gone down 9% Don’t know 2% Refused *
7. Do you think the average person is more likely to get HIV or AIDS or some other sexually transmitted disease like herpes or gonorrhea? (Do not read list. Enter only one response.)
HIV/AIDS 25% Other STD like herpes or gonorrhea 55% Both just as likely 12% Don’t know 7% Refused/No answer 1%
8. Does having a sexually transmitted disease, other than HIV or AIDS, make a person more vulnerable to being infected with HIV or AIDS, less vulnerable, or does it have no effect? (Do not read list. Enter only one response.)
More vulnerable 44% No effect 43% Less vulnerable 3% Don’t know 10% Refused *
9a. If you wanted to get tested to see if you were infected with a sexually transmitted disease, which one of the following would be the most important factor in choosing where to get tested? (Read and randomize list.)
Expertise of the person giving the test 56% Confidentiality 29% Convenience 7% Cost 6% Don’t know (do not read) 2% Refused/No answer (do not read) * (Delete answer given in QU. 9a. before displaying answers for QU. 9b. Keep QU. 9b. in same order as QU. 9a.)
9b. Of those items remaining, what would be the next most important? (Read list. Enter only one response.)
Confidentiality 44% Expertise of the person giving the test 27% Cost 14% Convenience 14% Don’t know (do not read) 1% Refused (do not read) *
10. If you were to get tested or treated for a sexually transmitted disease, would you be reluctant to use your normal health insurance arrangement?
Yes 29% No 68% Don’t know 2% Refused/No Answer 1%
11. A test is being developed that can be used at home to test for a sexually transmitted disease, other than AIDS or HIV. To use this test, you would buy a kit in a drug store, provide a urine sample, and send your sample to a laboratory. Then, you would get the results by calling a confidential telephone number. If you thought there was a chance you might have a sexually transmitted disease, how likely would you be to use this home test, very likely, somewhat likely, not too likely, or not at all likely? (Do not read list. Enter only one response.)
Likely (net) 57% -Very likely 34% -Somewhat likely 23%
Not Likely (net) 42% -Not too likely 14% -Not at all likely 28%
Don’t know 1% Refused/No answer *
12. Do you think most people really do each of the following, or not? Do you think most people really (insert phrase), or not?
Yes No Don’tKnow Refused Ask a new sexual partner if he or she is infected with any sexually transmitted diseases 12% 85% 3% * Tell a new sexual partner if they are infected with a sexually transmitted disease 11% 86% 3% * Use condoms each time they have sex with this new sexual partner 22% 75% 3% * Use protection when they have oral sex, like using a condom 4% 89% 7% * Get tested for sexually transmitted diseases before they have sex for the first time or stop using condoms 11% 85% 4% * Use condoms to prevent sexually transmitted diseases if they are already using a different kind of birth control to prevent pregnancy 31% 65% 4% *
13. Do you think the government should require that all health insurance plans pay for tests for sexually transmitted diseases?
Yes 66% No 32% Don’t know 2% Refused/No answer *
14. Do you think teens should have to get their parents’ permission to get tested and treated for sexually transmitted diseases, or not?
Yes 32% No 67% Don’t know 1% Refused/No answer *
15a. Do you think high schools should provide teenagers with information about sexually transmitted diseases and how they are spread?
Yes 95% No 4% Don’t know 1% Refused/No answer *
15b. Do you think high schools should make condoms available to those teenagers who want them to protect themselves against sexually transmitted diseases? (Do not read list. Enter only one response.)
Yes 53% No 44% It depends 1% Don’t know 2% Refused/No answer *
95-1773A-04b
The Kaiser Survey on Public Knowledge and Attitudes about STDs other than AIDS:Report Survey
Sexually Transmitted Diseases in America: Exposing the Epidemic
Provides some context about the STD epidemic, including taking a closer look at the prevalence of STDs in the United States, the long-term health consequences, and the public and private responses tothe epidemic, particularly, innovations in prevention, diagnosis and treatment.
Sexually Transmitted Diseases In America:
Exposing the Epidemic
November 20, 1996
Briefing Participants:
Peggy ClarkePresidentAmerican Social Health AssociationP.O. Box 13827Research Triangle Park, NC27709919/361-8400Press contact: Sharon Broom919/361-8416
Jacqueline Darroch Forrest, Ph.D.Vice President for ResearchThe Alan Guttmacher Institute120 Wall StreetNew York, NY 10005Press Contact: Susan Tew212/248-1111 ext. 208
Helene D. Gayle, M.D., M.P.H.Director, National Center forHIV, STD,and TB PreventionCenters for Disease Control and Prevention MSEO71600 Clifton RoadAtlanta, GA 30333Press contact: Melissa Shepard404/639-8890
Penelope Hitchcock, D.V.M., M.S.Chief, STD Branch, NIAIDNational Institutes of HealthRm. 3A21, Solar Building6003 Executive Blvd.Rockville, MD 20892301/402-0443
Azadeh Khalili Executive DirectorHIV/AIDS Technical Assistance Project131 Livingston St.Brooklyn, NY 11201718/935-5606
Felicia H. Stewart, M.D.Director of Reproductive HealthProgramsKaiser Family Foundation2400 Sand Hill RoadMenlo Park, CA 94025Press Contact: Tina Hoff,Communications Program Officer415/ 854-9400, ext. 106
Kathleen Toomey, M.D.State Epidemiologist andDirector, Epidemiology andPrevention BranchDivision of Public HealthDepartment of Human Resources2 Peachtree Street, NWAtlanta, GA 30303404/657-2588Press contact: Joyce Goldberg404/656-4937
Judith Wasserheit, M.D.Director, Division of STD/HIV PreventionCenters for Disease Control and Prevention MSEO21600 Clifton RoadAtlanta, GA 30333404/639-8260Press contact: Melissa Shepard404/639-8890
Other References:
American College of Obstetriciansand GynecologistsDepartment of Public InformationPO Box 96920Washington, DC 20090-6920Media Inquiries: (202)484-3321
Barbara LevineDirector of Government Relations and Affiliate AffairsAmerican Public Health Association1015 15th Street, NWWashington, DC 20005Press office: 202/789-5677Week of 11/17 – 11/19 only:212/261-6365
Marie BassProject Director, Reproductive Health Technologies ProjectBass and Howes1818 N Street, NWSuite 450Washington, DC 20036202/530-2900
Leslie Wolfe, Ph.D.PresidentCenter for Women Policy Studies1211 Connecticut Ave., NWSuite 312Washington, DC 20036202/872-1770
Tom Eng, W.M.D., M.P.H.Study DirectorInstitute of MedicineNational Academy of Sciences2101 Constitution AvenueWashington, DC 20418Press contact: Molly Galvin202/334-2138
Susan Wysocki, R.N.C., M.P.PresidentNational Association ofNurse Practitioners in ReproductiveHealth1090 Vermont Avenue, NWSuite 800Washington, DC 20005202/408-7025
Marilyn KeefeDirector of ServicesNational Family Planningand Reproductive Health Association122 C Street, NWSuite 380Washington, DC 20001202/628-3535
Carolyn PatiernoCo-ChairpersonSTD Prevention PartnershipDirector of Program ServicesSexuality Information andEducation Council of the UnitedStates (SIECUS)130 West 42nd Street, Suite 350New York, NY 10036-7802212-819-9770, ext.305
For information about local/regional spokespeople on STDs, call:Joan CatesAmerican Social Health Association919-361-8417
Sexually Transmitted Diseases in the United States: Exposing the Epidemic:Fact Sheet Q & A Resource List
Table 1Medicaid Beneficiaries by Group, 1988-1994 United States Beneficiaries (thousands) Average Annual Growth (%) Beneficiary Group 1988 1990 1992 1993 1994 1988-1994 1988-90 1990-92 1992-94 1988-94 All Beneficiaries 22,014 24,066 29,811 32,441 34,183 7.6 4.6 11.3 7.1 9.2
Cash Assistance 15,945 16,144 18,460 19,475 19,847 3.7 0.6 6.9 3.7 4.5
Other Beneficiaries 6,068 7,922 11,351 12,966 14,336 15.4 14.3 19.7 12.4 18.8 Elderly 3,130 3,167 3,547 3,680 3,828 3.4 0.6 5.8 3.9 4.1
Cash Assistance 1,664 1,532 1,573 1,564 1,574 -0.9 -4.1 1.3 0.0 -1.1
Other Beneficiaries 1,466 1,635 1,974 2,116 2,254 7.4 5.6 9.9 6.8 9.0 Blind and Disabled 3,443 3,717 4,471 4,991 5,381 7.7 3.9 9.7 9.7 9.3
Cash Assistance 2,753 2,966 3,517 3,906 4,223 7.4 3.8 8.9 9.6 8.9
Other Beneficiaries 690 750 954 1,085 1,159 9.0 4.3 12.8 10.2 10.9 Adults 5,081 5,696 6,982 7,451 7,860 7.5 5.9 10.7 6.1 9.1
Cash Assistance 3,867 3,865 4,379 4,568 4,571 2.8 0.0 6.4 2.2 3.4
Other Beneficiaries 1,214 1,831 2,603 2,884 3,288 18.1 22.8 19.2 12.4 22.0 Children 10,360 11,486 14,811 16,319 17,115 8.7 5.3 13.6 7.5 10.6
Cash Assistance 7,662 7,781 8,992 9,437 9,479 3.6 0.8 7.5 2.7 4.3
Other Beneficiaries 2,698 3,706 5,820 6,882 7,635 18.9 17.2 25.3 14.5 23.1 Source: Urban Institute calculations based on HCFA 2082 data. Does not include the US Territories. Totals may not add due to rounding. “Cash” refers to beneficiary groups who receive AFDC or SSI. “Other” groups (non-cash, poverty-related) include the medically needy, poverty-related expansion groups, and 1115 waiver eligibles (where identifiable). Beneficiaries are defined as individuals enrolled in the Medicaid program who actually receive medical services.
Over 4 million Southern Children have no Health Insurance
Embargoed for release until: 8:30 am, ET, Monday, December 9, 1996
For more information contact: Chris Ferris (202)347-5270
New Study:
Despite Recent Gains, South Still Home to Disproportionate Share ofNation’s Uninsured Children
Washington, D.C. — A new report, sponsored by the Kaiser Family Foundation and prepared by the Southern Institute on Children and Families, finds that the South was home to 4.1 million uninsured children in 1993. The number of uninsured children in the South declined 3 percent between 1989 and 1993, at the same time the number of uninsured children in the country on the whole increased 9 percent (Figure 1). Over a third (36 percent) of the nation’ children live in the South, but the region accounted for a disproportionatelyhigh share (43 percent) of America’uninsured children (Figure 2).
“Although we witnessed a reduction in the number of uninsured children in the South,” said Sarah Shuptrine, principal author of the study, “in some states as many as one in four children are still uninsured.” The proportion of uninsured children in the South ranged from 25 percent in Louisiana to 10 percent in North Carolina and Missouri. Nineteen percent of the children in Texas, the largest state in the region, were without insurance. These 1 million uninsured Texan children accounted for one-fourth of all uninsured children in the South.
The reductions in the number of uninsured children in the South were due in part to changes in federal Medicaid laws that required states to expand income eligibility levels for children and to increase gradually the minimum eligibility age. All but three Southern states expanded eligibility levels beyond the federal requirements, making even more children eligible for coverage under Medicaid.
The number of uninsured children under age 6–the focus of Medicaid expansion efforts–decreased by 37 percent in the South during this period. In contrast, the number of uninsured teenagers (age 13-18) increased 31 percent (Figure 3). That more younger children have insurance is closely related to the targeted extension of Medicaid coverage to these age groups.
“The impact of Medicaid expansions is clear when the changes in number of uninsured children between 1989 and 1993 are examined by age groups,” said Diane Rowland, Senior Vice President of the Kaiser Family Foundation. “Medicaid has filled many of the gaps in health insurance for children, but not all children eligible for Medicaid are currently covered.” Lack of information about the availability of Medicaid coverage and eligibility barriers leave many Southern children outside of the program’s reach.
The report suggests steps that states could take to increase enrollment in Medicaid that do not require federal waivers: raising age and income eligibility levels even further; eliminating the Medicaid assets test for children; and engaging in outreach to enroll children already eligible for Medicaid.
The study analyzed 1994 Current Population Survey (CPS) data for 17 Southern states and the District of Columbia. Because of recent revisions to the CPS questionnaire, the 1994 CPS–which provided 1993 data–is the latest that can be reliably compared to earlier years. The report provides estimates of the number of uninsured children in 1993, trends in the number of uninsured children between 1988 to 1993, and 1996 Medicaid eligibility levels for each of the states. Data from the following states, along with the District of Columbia, were included in this report’s analysis: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia.
The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries.
Single copies of Uninsured Children in the South are available by calling the Kaiser Foundation’s publication request line at 1-800-656-4533.
Uninsured Children in the South:Press Release Fact Sheet
Second Report
The Southern Institute on Children and Families released the first report on Uninsured Children in the South in November 1992. The report provided estimates of uninsured children by state with age and income breakouts related to Medicaid. This is the second report on Uninsured Children in the South. It provides estimates of uninsured children in each southern state from two perspectives: number of uninsured children in 1993 with percent of uninsured children by age and income ranges, and decline or increase in the number of uninsured children between 1989 and 1993. Included in this report are fact sheets for the southern region as a whole and for the 17 southern states and the District of Columbia. The fact sheets contain state specific elegibility levels for Medicaid children. The source of the estimates of uninsured children is the Current Population Survey (CPS). The data were prepared by The Urban Institute using data specifications submitted by the Southern Institute on Children and Families for 1989 and 1993.
Medicaid Expenditures and Beneficiaries: 1994 Update
October 1998
Medicaid is the nation’s major public financing program for low-income Americans. After several years of rapid increase in the early 1990s, enrollment and spending growth have moderated and returned to historical levels. For the second consecutive year, annual growth in Medicaid spending was under 10 percent. The estimates presented in this policy brief are based on analyses prepared by The Urban Institute and update previous analyses conducted for the Kaiser Commission on the Future of Medicaid.
Medicaid in 1994
In 1994, Medicaid financed health care services for 34.2 million low-income individuals at a cost of $137.1 billion federal and state dollars. Spending including administrative costs and other adjustments totaled $143.7 billion. Medicaid serves multiple roles for the populations it covers. For adults and children in low-income families, it provides health care coverage for medical care. For persons with special needs and disabilities, and for the nursing home elderly, it also finances long-term care assistance. For low-income elderly and disabled Medicare beneficiaries, it pays for Medicare’s premium and cost-sharing requirements and can provide coverage for additional services.
In 1994, the Medicaid program covered health care services for 17.1 million children and 7.9 million low-income adults at a cost of $23.3 billion and $15.5 billion, respectively (Figure 1, Tables 1 and 2). This low-income population is generally comprised of adults and children in AFDC families; low-income infants, children and pregnant women; medically needy individuals, and those with coverage extended through Section 1115 Demonstration waivers.
In 1994, 5.4 million nonelderly people with developmental disabilities, severe mental illness, and physical disabilities received Medicaid assistance. Because of their complex health care needs, they often require both expensive acute and long-term care assistance. Spending on services for this population was $45.3 billion in 1994.
Medicaid financed services for 3.8 million elderly persons at a cost of $36.1 billion. In addition to financing acute and long-term care services, Medicaid also pays Medicare’s cost sharing, premiums, and deductibles for approximately 3.7 million low-income Medicare beneficiaries (QMBs and SLMBs).
Medicaid pays for a wide spectrum of services including acute medical and long-term care services. It also pays for HMO and Medicare premiums, as well as special payments to hospitals that care for a disproportionately large share of uninsured individuals and Medicaid beneficiaries, known disproportionate share hospitals (DSH).
Inpatient hospital care spending accounted for 19 percent of spending; prescription drug payments, 6 percent; and physician and outpatient care, 13percent of spending (Figure 3). About 7 percent of Medicaid spending paid for premiums to HMOs and other managed care plans as well as to Medicare.
In 1994, about 21 percent of spending went to nursing homes and 6 percent covered home care expenses for persons living in the community. Another 7 percent financed care in intermediate care facilities for the mentally retarded (ICF-MR) and the remaining 2 percent covered mental health services.
Medicaid spent $16.9 billion on DSH payments in 1994. DSH payments are declining as a share of Medicaid spending.
Recent National Trends
Enrollment
Medicaid enrollment has risen steadily in recent years. Over the past four years, enrollment has increased by 10 million people from 24 million in 1990 to over 34 million in 1994 (Figure 4). From 1990 to 1992, Medicaid enrollment rose an average of 11.3 percent per year. This growth occurred in response to federal and state expansions in eligibility and the economic recession that increased the number of people eligible for Medicaid coverage. Enrollment is growing more slowly, increasing 5.4 percent from 1993 to 1994 compared to an 8.8 percent increase from 1992 to 1993 (Table 1).
Two thirds of the new enrollment in 1994 was among children (46 percent) and low-income adults (23 percent). While the number of persons eligible for Medicaid increased, the rate of growth in enrollment has generally slowed (Table 1). Enrollment among the disabled population rose 7.8 percent, marking a reduction from 11.6 percent in 1993. Although low-income children and adults accounted for the majority of the new beneficiaries, enrollment in these populations only rose 5.5 percent and 4.9 percent, respectively.
In 1988, nearly three quarters (72 percent) of Medicaid beneficiaries qualified for Medicaid because they received cash assistance (Figure 5). By 1994, this number had fallen to 58 percent. This is occurring because Medicaid was expanded in recent years to extend eligibility to certain populations who are low-income, but do not qualify for cash assistance. Although enrollment in both populations is rising, average annual growth in the cash assistance population was 3.7 percent between 1988 and 1994 compared to 15.4 percent for populations who qualify because of poverty-related eligibility such as pregnant women, infants, young children, and Qualified Medicare Beneficiaries (QMBs), or through the medically needy option.
Costs
The rapid rate of Medicaid spending growth seen in the early 1990s has largely subsided. From 1993 to 1994, Medicaid spending rose only 7.6 percent, substantially lower than earlier projections exceeding 10 percent annual growth. In the early 1990s, growth in Medicaid spending peaked at 28 percent. Earlier Kaiser Commission analyses found that this rapid growth was equally attributable to three major factors: medical price inflation, rapid enrollment growth, and state financing mechanisms that permitted states to receive additional levels of federal support.
From 1993 to 1994 , Medicaid spending increased 7.6 percent, rising from $127.4 billion to $137.1 billion (Figure 6). This was the smallest annual net increase in the past four years. Reductions in spending growth reflect federal limits on state use of provider taxes and donations, caps on DSH payments, a slowing in the rate of medical price inflation, and lowered enrollment growth.
This marks a dramatic departure from 1991 when growth in payments for DSH peaked, increasing over 250 percent in one year (Table 2). Federal legislation enacted in 1991 which capped DSH spending has effectively curtailed the growth in these payments.
Growth in Medicaid spending can be attributed to three basic factors: enrollment, the average amount spent per beneficiary, and DSH payments. DSH payments, which had accounted for nearly half of the increase from 1991 to 1992 when growth was fastest, were a negative contributor to growth (-1.3 percent). In other words, if the decline in DSH payments had been the only change in Medicaid, spending would have actually fallen by $125 million. Because DSH payments were down, the relative contribution of enrollment to spending increase was larger at 71 percent, even though actual enrollment growth was only 5.4 percent.
From 1993 to 1994, the share of spending growth attributable to hospital inpatient care, hospital outpatient, clinic and physician care either fell or stayed the same. In contrast, payments to HMOs accounted for 18 percent of the total growth in Medicaid spending, up from 10 percent in the prior year. While this may not reflect actual changes in spending, it does represent a shift in how Medicaid accounts for its expenditures. As growth in managed care continues, particularly in capitated payments, it will become increasingly difficult to know how spending is allocated by service.
State Variations: 1992 to 1994
Medicaid is jointly financed by the states and federal government, but states administer the program and have considerable latitude in setting eligibility levels, scope of benefits, and provider payment rates. Consequently, sizable variation is evident in enrollment and spending growth and per beneficiary costs at the state level.
Every state reported an increase in enrollment in the 1992 to 1994 period, but the size of the increase varied measurably. Although the average for the nation was a 7.1 percent increase in the number of beneficiaries, in states such as Tennessee and Montana, enrollment growth exceeded 20 percent (Table 4). In contrast, the rise in enrollment was under 2 percent in Massachusetts and Minnesota, states that already had relatively broad programs.
Average spending per beneficiary is determined in large part by the breadth of the state’s program, the composition of the Medicaid population, and local costs for health care services. Overall, spending per beneficiary was lowest in the South and highest in the Northeast. The US average was $4,011. States ranged from a low of $2,167 per beneficiary in Tennessee to a high of $6,447 per beneficiary in New York.
Nationally, program spending on services grew at an average annual rate of 9.1 percent between 1992 and 1994, ranging from a high of 20.7 percent in Hawaii and low of a reduction of 0.2 percent in Rhode Island. State policies on scope of benefits, eligibility, provider payment levels, DSH payments, and use of managed care all affect the growth in Medicaid spending.
This policy brief is based on an analysis conducted by the Urban Institute for the Kaiser Commissionon the Future of Medicaid. The full report “Medicaid Beneficiaries and Expenditures: National and State Profiles and Trends, 1988 to 1994” can be obtained from the Kaiser Commission by calling 1-800-656-4533.
The Kaiser Commission on the Future of Medicaid was established by the Henry J. Kaiser Family Foundation in 1991 to serve as a forum for analyzing, debating, and proposing future directions for Medicaid reform. The Commission and the Foundation are wholly separate from The Kaiser Permanante Medical Care Program and the Kaiser Industries.
Medicaid Expenditures and Beneficiaries:Policy Brief Tables Chart Pack
This policy brief analyzes Medicaid enrollment and spending in 1994. It examines changes in program enrollment and spending between 1992 and 1994 and explains the factors behind the spending growth. Detailed tables and trend information can be found in Medicaid Expenditures and Beneficiaries: National and State Profiles and Trends, 1984-1994 (#2045).This data book provides extensive informationon Medicaid expenditures and beneficiaries nationally and for each state in 1994. Information is included by type of service and beneficiary group (children, adults, elderly, and disabled). Trend informationon growth in beneficiaries and expenditures in each state is also included, as well as an analyses of the factors contributing to increases in Medicaid expenditures over the 1988-1994 period.
Over 4 million children living in the South have no health insurance coverage. While the South experienced a decrease (3 percent) in the number of uninsured children from 1989 to 1993 — the number of uninsured children nationally increased by 9 percent (Figure 1) — the region accounts for a dispro-portionately high share of uninsured children in America. Over a third (36 percent) of American children live in the South, but the region accounted for 43 percent of America’s uninsured children (Figure 2).
Uninsured rate varies across States
Overall, 15 percent of children in the South are uninsured, but southern states vary widely in the proportion of their children without health insurance coverage.
Older children most at risk
Of the 4 million uninsured, 43 percent were between the ages of 13 and 18 years; school age children 6 through 12 accounted for 37 percent; and preschool children under age 6 accounted for 20 percent. In 1993, 1.8 million southern teenagers had no insurance, of whom one third were poor.
The number of uninsured children under age 6 — the focus of initial Medicaid expansion efforts — decreased by 37 percent in the South between 1989 and 1993 (Figure 3). In contrast, the number of uninsured teenagers increased 31 percent.
Medicaid’s Role
Medicaid is the federal-state health program for the poor. Reductions in the number of uninsured children in the South are largely attributable to changes in federal Medicaid laws that required states to expand income eligibility levels for children and to gradually increase the minimum eligibility age. Recent federal legislation required states to provide Medicaid coverage to children:
Issues
These findings demonstrate the important role that Medicaid plays in covering children. However, Medicaid’s potential for covering uninsured children in the South is not fully realized, evidenced by the fact that 28 percent of uninsured children are poor. This is in part due to the fact that eligibility levels for teenagers (the ages where federal requirements for coverage of the poor have yet to be phased-in) still vary widely by state. For example, Texas covers only teens living in families who meet its state established AFDC eligibility levels — income below 17 percent of the federal poverty level.
In addition, not all children who are eligible for Medicaid participate in the program. Lack of information about the availability of Medicaid coverage, as well as eligibility barriers affect the ability of many needy families to gain Medicaid coverage for their children. In addition, recent changes in welfare policy and coverage of disabled children have the potential to reduce the number of children covered by Medicaid and to make information about the availability of Medicaid program more difficult to obtain.
Data presented in this factsheet are based on Uninsured Children in the South, prepared by the Southern Institute on Children and Families, November 1996. That study analyzed the 1994 Current Population Survey (CPS) data for 17 southern states and the District of Columbia. Because of recent revisions to the CPS questionnaire, 1994 — which provided 1993 data — is the latest that can be reliably compared to earlier years. Data are included for the District of Columbia and the following states: Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia.
The Henry J. Kaiser Family Foundation is an independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. Established in 1948 by industrialist Henry J. Kaiser, the Foundation focuses its work on four main areas: health policy, reproductive health, HIV, and health and development in South Africa.
Uninsured Children in the South:Press Release Fact Sheet