Nonresident Fathers:
To What Extent Do They Have Access to Employment-Based Health Care Coverage?

Appendices

[ Title Page of Report | Executive Summary | Report ]

Contents

  1. Effect of Reweighting on the Estimates
  2. Methodology for Imputing Employer Offer Of Dependent Coverage
  3. Numbers Behind the Percentages Presented in the Tables
  4. Impact of Additional Coverage, by Race and Child Support Status

Appendix A:
Effect of Reweighting on the Estimates

In order to obtain the results presented in this report, it was first necessary to reweight the data to produce a profile of nonresident fathers that reflects the entire population of nonresident fathers, rather than just those identified in the SIPP. The reweighted data represent the entire population of nonresident fathers, including those who are absent from the SIPP as a result of the census undercount, incarceration or other institutionalization, or military service. Additional adjustments are made to compensate for the apparent underreporting of fertility by nonresident fathers in the SIPP. This appendix summarizes the development of the new weights, and discusses the effect of reweighting on the estimates of nonresident fathers' access to health care coverage. See Sorensen and Wheaton (2000) for a more detailed description of the development of the reweighting procedure.

Reweighting the Data

The 1993 SIPP data show that there are about 10.2 million mothers with children under 18 years of age who have a father living elsewhere. However, the procedures used to identify nonresident fathers in the SIPP find only about 8 million nonresident fathers. Thus, assuming an equal number of custodial mothers and nonresident fathers, only about 78 percent of all nonresident fathers are identified in the SIPP. Black nonresident fathers are more likely to be underrepresented in the SIPP than are nonblack nonresident fathers. Only 59 percent of black nonresident fathers are identified, compared to 86 percent of nonblack nonresident fathers. Although these figures may sound low, they are better than those found in any other data source.

There are three basic reasons why nonresident fathers are underrpresented in the SIPP. First, the SIPP is a household survey and so excludes the incarcerated and other institutionalized population and those residing in military barracks or serving in the military overseas. Second, the SIPP reflects the census undercount of certain populations, especially young African American males. Finally, some nonresident fathers are present in the SIPP but not identified as nonresident fathers because they underreport their fertility or are otherwise excluded from the sample through the screens used to identify nonresident fathers.

Based on data from the Census Bureau, the U.S. Department of Defense, and the U.S. Department of Justice, an estimated 606,000 nonresident fathers are absent from the SIPP due to incarceration or other institutionalization, 56,000 are absent due to residence in military barracks or service in the military overseas, and 883,000 are absent due to the census undercount. The remaining 686,000 deficit of nonresident fathers is assumed to be composed of nonresident fathers who are present in the SIPP but cannot be identified as nonresident fathers.

To reweight identified nonresident fathers in order to represent all nonresident fathers, assumptions must be made about the characteristics of the missing nonresident fathers. Incarcerated and other institutionalized nonresident fathers are assumed to resemble nonresident fathers who are impoverished and do not pay child support, except that they have no income and do not work. For the purpose of reweighting, "impoverished" is defined as having family income below the official poverty threshold based on family size and/or having personal income below the poverty threshold for a single individual. Nonresident fathers who are missing from the SIPP due to residence in military barracks or service in the military overseas are assumed to resemble the military nonresident fathers present in the SIPP. Those absent due to the census undercount are assumed to resemble impoverished nonresident fathers identified in the SIPP.

Once incarceration and other institutionalization, military service, and the census undercount have been accounted for, final adjustments are made for the nonresident fathers who are present, but not identified in the SIPP. The reweighting is done in such a way that the total reweighted number of nonresident fathers reporting payment of child support (referred to here as payers) is as close as possible to the number of custodial mothers reporting receipt, and the distribution of nonresident fathers by race and ethnicity matches that of custodial mothers as closely as possible. Payers and nonpayers are allocated into impoverished and nonimpoverished payers and nonpayers, based on the percentages of identified SIPP black and nonblack payers and nonpayers who are impoverished. After reweighting, the number of nonresident fathers matches the number of custodial mothers. About 45 percent of nonresident fathers report paying child support, compared to 46 percent of custodial mothers, and the number of nonresident fathers of each race and ethnicity (black, white, Hispanic, and other) is within two percentage points of the corresponding number of custodial mothers.

Table A.1 presents the multiplicative adjustments to the nonresident father weights used in reweighting the data. Since it is necessary to change the work status and income variables of impoverished nonpaying nonresident fathers for the purpose of representing the incarcerated and other institutionalized, the records of impoverished nonpayers are "cloned", and the income and work variables are set to zero. Since there are fewer incarcerated and other institutionalized fathers than identified impoverished nonpayers, the adjustments to the weights are less than one. The adjustment to the weights for nonblack military men is also less than one, since it appears that military service is overreported in the SIPP. No adjustment is made to the weights of fathers aged 55 or older. The remaining adjustments range from 1.01 for nonimpoverished, nonblack, nonpayers to 2.379 for impoverished black payers.

Table A.1:
Adjustments to the 1993 SIPP Population Weight used in Reweighting the File
  Black Nonblack
Civilian Nonresident Fathers Under Age 55
Impoverished* Payers 2.3790 1.5583
Impoverished Nonpayers 1.9567 1.4810
Nonimpoverished Payers 1.5248 1.0942
Nonimpoverished Nonpayers 1.1247 1.0130
Military Nonresident Fathers** 1.4742 .6658
Incarcerated/Institutionalized Nonresident Fathers*** .7191 .4022
Nonresident Fathers Aged 55 and Over 1.0000 1.0000
* "Impoverished" is defined as having family income below the official poverty threshold based on family size, and/or having personal income below the poverty threshold for a single individual.

** In comparing SIPP counts of men in the military to Census data, there appear to be too many SIPP men reporting membership in the armed forces. The SIPP finds more nonblack military men than actually exist in the entire military, including barracks and overseas. The number of black military men in the SIPP exceeds the number not in barracks or overseas, but is less than the total in the armed forces. The adjusted weights correct for this.

*** Since the incarcerated and other institutionalized are excluded from the SIPP, dummy records are created for them. To do this, the records of impoverished nonpayers are duplicated, but their financial and work data are set to zero. The incarcerated/institutionalized weight adjustments are then applied to the copied records, and the impoverished nonpayer weight adjustments are applied to the original set of records.

Source: Sorensen and Wheaton (2000).

Effect of Reweighting on Estimates of Nonresident Fathers' Access to Health Care Coverage

The overall population of nonresident fathers appears worse off financially than the population of nonresident fathers identified in the SIPP. For example, 20 percent of reweighted nonresident fathers are officially poor, compared to 11 percent of identified nonresident fathers (for this, and other statistics, see Sorensen and Wheaton 2000). This is not surprising, since reweighting incorporates the typically low-income incarcerated or institutionalized and undercounted nonresident fathers into the estimates.

Given that reweighting introduces more poor nonresident fathers into the estimates, it is to be expected that reweighting will lower the estimates of the percentage of nonresident fathers with access to health care coverage. To provide insight into the effect of reweighting on the estimates, Table A.2 presents the same results as Table 5, but only for identified nonresident fathers and using the original 1993 SIPP population weights.

As can be seen by comparing Table A.2 and Table 5, reweighting increases the number of nonresident fathers who do not provide health care coverage in the first four months of 1993 from about 6 million (75 percent of all identified nonresident fathers) to about 8 million (78 percent of all reweighted nonresident fathers). Whereas 52 percent of reweighted nonproviders are estimated to be without access to dependent health care coverage, 44 percent of identified nonresident fathers are estimated to lack access. Of those without access, a smaller percentage of the reweighted nonresident fathers are estimated to lack access because their firm does not offer coverage (38 percent) than is the case for identified nonresident fathers (50 percent), and a higher percentage are estimated to lack access due to unemployment or incarceration.

Clearly, reweighting lowers the estimates of nonresident fathers' access to dependent health care coverage. However, even when the estimates are restricted to the better-off population of identified nonresident fathers, no more than 56 percent of nonproviders have access to dependent health care coverage.

Table A.2:
Nonproviders' Access to Health Care Coverage (SIPP Weights) "Identified" Nonresident Fathers Only and Using Original SIPP Weights
  Nonresident Father Income Level
<200% Poverty 200% Poverty+ Total
Total (thousands) 2,381 3,615 5,996
  (100%) (100%) (100%)
Has Access to Dependent Coverage 25% 57% 44%
Possibly Has Access to Dependent Coverage 11% 12% 12%
Does Not Have Access to Dependent Coverage 64% 31% 44%
Has Access (thousands) 585 2,076 2,661
  (100%) (100%) (100%)
Has Dependent Coverage for Resident Family 42% 45% 45%
Has Individual Coverage, Dependent Coverage Offered 58% 55% 55%
Possibly Has Access (thousands) 263 429 692
Does Not Have Access (thousands) 1,533 1,110 2,643
  (100%) (100%) (100%)
Has Individual Coverage, Dependent Not Offered 7% 16% 11%
Not Covered, Firm Offers Individual Coverage 1% 3% 2%
Not Covered, Firm Doesn't Offer Any Coverage 35% 41% 37%
Self-Employed 8% 20% 13%
Not Working 49% 20% 37%
Incarcerated NA NA NA
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

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Appendix B:
Methodology for Imputing Employer Offer Of Dependent Coverage

The SIPP data provide detailed information about health care coverage, but do not indicate whether a worker without dependent coverage from his employer works for a firm that offers coverage. Therefore, the employer offer of dependent coverage is imputed using data from the April 1993 Current Population Survey Employee Benefits Supplement (CPS). The imputation predicts whether a worker is employed in a firm that offers coverage, regardless of whether or not the worker himself is eligible for the firm's coverage.

There are two steps to the imputation, each of which is described in greater detail below. First, a logit model is used to impute whether a worker who is not covered through his own employer works in a firm that offers health care coverage. The logit model is from the Urban Institute's TRIM3 microsimulation model (Transfer Income Model Version 3), and was estimated using data from the April 1993 CPS. (20) The model estimates the likelihood that the worker is in a firm that offers any health care coverage, regardless of whether dependent coverage is offered. The second step in the imputation is to estimate the percentage of workers with individual coverage or an offer of employer coverage that work in firms that offer dependent coverage.These percentages are derived from tabulations of the April CPS and control for marital status and income level.

TRIM3 Imputation of Employer Offer

Table B.1 displays the logit equation used to impute whether a worker without coverage from his employer works for a firm that offers coverage. Self-employed men and employees of state and federal governments are excluded from the equation. Self-employed men without coverage are assumed not to work in a firm that offers coverage. Employees of state or federal governments are counted as working for an employer that offers coverage, since the federal government and all states offer health care coverage to some of their employees. The equation was estimated on all workers, not just men. A dummy variable for male is included in the equation, since men without coverage through their employer are less likely to work in a firm that offers coverage than are women, all else held constant. To estimate whether or not a man works in a firm that offers coverage, his characteristics are entered into the equation and the resulting value is converted to a probability. A uniform random number with a value of 0 to 1 is then drawn. If the random number is less than or equal to the probability, the man is assumed to work in a firm that offers coverage.

Table B.1:
TRIM3 Employer Offer Logit Model For Predicting
Whether A Private Sector or Local Government Worker Without Coverage
Works in a Firm that Offers Coverage
  Parameter Estimate Pr > Chi-Square Odds Ratio
Intercept .4307 .0031 1.538
Weekly Earnings (in $100s) .0631 .0001 1.065
Male -.1851 .0067 .831
Dependent Child (includes students<23) .4088 .0003 1.505
Under Age 30 .1542 .0348 1.167
High School Graduate (highest attained) .5878 .0001 1.800
Some College .5730 .0001 1.774
College Degree .9789 .0001 2.662
Spouse Has Family Coverage .8245 .0001 2.281
Firm Size: 1-24 Employees -2.6025 .0001 .074
Firm Size: 25-99 Employees -.9894 .0001 .372
Agriculture, Mining, Construction -.6509 .0001 .522
Transportation, Communication, Utilities -.2321 .1871 .793
Wholesale Trade -.1206 .5390 .886
Retail Trade -.2024 .0772 .817
Finance, Insurance, Real Estate .1209 .4741 1.129
Services -.0863 .4376 .917
Local Government .6750 .0097 1.964
Midwest .0349 .6920 1.036
South -.2773 .0013 .758
West -.2816 .0020 .755
Association of Predicted Probabilities and Observed Responses
Concordant = 83.7%
Discordant = 16.2%
Tied = 0.2%
(11,696,336 pairs)
Somers' D = 0.675
Gamma = 0.676
Tau-a = 0.337
c = 0.837

Percentage Offered Dependent Coverage

Once a man has been identified as having individual coverage from his employer or working in a firm that offers coverage, it is necessary to impute whether or not his employer offers coverage for dependents. Table B.2 displays men who work for private or public sector firms that offer health care coverage, as tabulated from the April 1993 CPS. Most men employed in firms that offer health care coverage work in a firm that offers dependent coverage. The percentage with an offer of dependent coverage ranges from 90 percent for low-income unmarried men to 97 percent for higher-income married men. However, looking only at men with individual coverage, the percentage with an offer of dependent coverage drops, especially for married men. Only 56 percent of low-income and 80 percent of higher-income married men with individual coverage work in a firm that offers dependent coverage. It is not surprising that men with individual coverage are less likely to work in a firm that offers dependent coverage, since the reason that some of these men have individual coverage is that dependent coverage is unavailable. The bottom panel of Table B.2 shows the percentage of men declining or ineligible for the employer's offer of coverage who are in a firm that offers dependent coverage. The percentages are not much different than the percentages for all men in firms that offer coverage.

The percentages from Table B.2 are incorporated into the estimates of nonresident fathers' access to dependent health care coverage as follows. Nonresident fathers with individual coverage are divided into four groups by income and marital status. The appropriate percentage from Table B.2 is applied to each group in order to estimate the number with access to dependent coverage. For example, there are 140,850 nonresident fathers with individual coverage who are married and have incomes beneath 200 percent of the poverty threshold (not shown). Of these, 78,876 (56 percent) are assumed to work in a firm that offers dependent coverage. The four groups are then summed to yield the total number of nonresident fathers with individual coverage who work in a firm that offers dependent coverage. The same approach is used for nonresident fathers without coverage from their employers who have been imputed to work in firms that offers coverage. Of 143,338 low-income married nonresident fathers without coverage but in a firm that offers, 133,849 (93 percent) are assumed to work in a firm that offers dependent coverage.

Table B.2:
Percentage of Men Working in Firms That Offer Health Care Coverage
Who Work in a Firm That Offers Dependent Coverage
  Married Not Married
<200%
Poverty
200%
Poverty+
<200%
Poverty
200%
Poverty+
N 1,084 5,079 468 2,409
Weighted Number (thousands) 4,825 22,840 2,195 11,640
Percentage Offered Dependent Coverage 92% 97% 90% 91%
Number With Individual Coverage 700 2,680 859 7,878
Percentage Offered Dependent Coverage 56% 80% 83% 89%
Number Without Coverage Through Own Employer 943 2,376 957 2,006
Percentage Offered Dependent Coverage 93% 96% 92% 91%
Source: Author's analysis of the April 1993 Current Population Survey Employee Benefits Supplement.

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Appendix C:
Numbers Behind the Percentages Presented in the Tables

The tables in Appendix C duplicate the tables in the text but show the numbers behind the percentages. Table 6 is excluded, since it already contains all relevant numbers. For convenience in calculations, the raw numbers (prior to rounding) are shown. However, the data do not support estimates to this level of precision, so estimates should be rounded to millions or thousands before citing.

Table C.1:
Characteristics of Custodial Mothers and Nonresident Fathers in 1993
  Custodial Mothers Nonresident Fathers
Sample Size 1,758 1,285
Number 10,226,142 10,226,845
Income Level
<100% of Poverty Threshold 3,759,381 2,090,116
100-199% of Poverty Threshold 2,877,115 1,992,134
200%+ of Poverty Threshold 3,590,516 6,144,596
Receives/Pays Child Support 4,725,263 4,638,893
Receives/Provides Health Care Coverage in year 2,426,268 3,097,306
Receives/Provides Health Care Coverage in first four months 1,664,861 2,227,146
 
Families with formal written order or agreement (thousands) 5,101,800 na
Receives Child Support 3,897,132 na
Receives Health Care Coverage in year 1,788,566 na
Receives Health Care Coverage in first four months 1,302,560 na
Note: The population weights of nonresident fathers are adjusted to account for all nonresident fathers, including those missing from the SIPP due to the Census undercount, incarceration or other institutionalization, and military residence in barracks or overseas.

Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.2:
Provision for Health Costs in the Child Support Award or Agreement
  Custodial Family Income Level
<200% Poverty 200% Poverty+ Total
Families with a Formal Child Support Award or Agreement 2,857,647 2,244,153 5,101,800
Provision for Health Costs in Award:
Nonresident Father to Provide Health Care Coverage 1,062,170 846,229 1,908,399
Custodial Family to Provide Health Care Coverage 320,443 479,676 800,119
Other Provision for Health Costs 248,378 193,749 442,127
No Provision for Health Costs 1,226,656 724,499 1,951,155
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.3:
Health Care Coverage of Children in Custodial Families in 1993
  Custodial Family Income Level
<200% Poverty 200% Poverty+ Total
All Custodial Families 6,636,496 3,590,516 10,226,142
Health Care Coverage Provided By:*
Nonresident Father 1,355,758 1,070,510 2,426,268
Custodial Family 1,396,402 2,192,185 3,588,587
Medicaid/Medicare Only 3,345,992 195,993 3,541,985
Uninsured 538,345 131,827 607,172
With Private Coverage Entire Year 1,533,750 2,821,196 4,354,945
Father Required to Provide Health Care Coverage Under Award or Agreement 1,062,170 846,229 1,908,399
Health Care Coverage Provided By:*
Nonresident Father 697,467 601,030 1,298,496
Custodial Family 128,312 204,341 332,653
Medicaid/Medicare Only 190,443 14,441 204,854
Uninsured 45,949 26,447 72,396
With Private Coverage Entire Year 514,450 730,802 1,245,252
Award or Agreement, but Father Not Required to Provide Health Care Coverage 1,795,477 1,397,924 3,193,401
Health Care Coverage Provided By:*
Nonresident Father 263,343 226,727 490,070
Custodial Family 474,868 1,075,678 1,550,547
Medicaid/Medicare Only 924,817 45,179 969,996
Uninsured 132,448 50,341 182,789
With Private Coverage Entire Year 403,463 1,165,073 1,568,536
No Award or Agreement 3,778,849 1,346,363 5,125,212
Health Care Coverage Provided By:*
Nonresident Father 394,948 242,754 637,702
Custodial Family 793,221 912,166 1,705,388
Medicaid/Medicare Only 2,230,732 136,403 2,367,135
Uninsured 359,948 55,040 414,987
With Private Coverage Entire Year 615,837 925,321 1,541,158
* If at least one custodial child receives health care coverage from a given source in at least one month of the year, then the family is considered to have received health care coverage from that source. The family is placed into the first of the categories that applies to it.

Source: Author's Analysis of the 1993 Survey of Income and Program Participation.

Table C.4:
Nonresident Fathers, By Months Provided Coverage in 1993
  Months Provided Health Care Coverage to Nonresident Children in 1993 Total
All Some None
Nonresident Fathers 1,377,091 1,720,216 7,129,539 10,226,845
Poor 9,008 27,244 2,053,863 2,090,116
Not Poor 1,368,083 1,692,972 5,075,676 8,136,729
Father's Own Income (1998 dollars)
< $10,000 0 62,853 3,037,329 3,100,181
$10,000 to $19,999 114,643 338,867 1,737,063 2,190,573
$20,000 to $39,999 745,962 827,884 1,646,969 3,220,815
$40,000+ 516,485 490,612 708,178 1,715,276
Work Status During Year
Full-Time All Year 1,217,240 1,490,057 3,051,092 5,758,389
Part-Time and/or Part-Year 159,851 195,755 2,182,320 2,537,926
No Work or Incarcerated 0 34,404 1,896,127 1,930,531
Work Status By Income Level
Full-Time All Year: 200% Poverty + 1,168,084 1,289,228 2,301,161 4,758,472
Full-Time All Year: < 200% Poverty 49,157 200,829 749,931 999,917
Other: 200% Poverty + 138,290 142,865 1,104,969 1,386,123
Other: < 200% Poverty 21,561 87,294 2,973,478 3,082,333
Education
Less than high-school degree 140,442 178,109 2,268,870 2,587,421
High School Degree/GED 609,754 945,495 3,040,381 4,595,630
At Least Some College 626,894 596,612 1,820,288 3,043,794
Marital Status
Never Married 80,314 168,491 2,175,590 2,424,395
First Marriage 50,986 320,584 1,582,281 1,953,851
Remarried 562,721 480,864 1,308,009 2,351,594
Divorced/Separated 683,069 750,277 2,063,658 3,497,005
Age
17-24 32,164 89,923 1,060,838 1,182,925
25-34 435,755 582,099 2,512,930 3,530,783
35+ 909,172 1,048,194 3,555,771 5,513,138
Race/Ethnic Composition
Black 192,449 340,162 2,210,087 2,742,699
Hispanic 112,430 145,168 1,119,302 1,376,900
White 1,059,632 1,229,820 3,629,673 5,919,126
Other 12,579 5,065 170,477 188,120
Pay Child Support During Year
Yes 1,188,233 1,073,091 2,377,569 4,638,893
No 188,858 647,125 4,751,969 5,587,952
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.5:
Nonproviders' Access to Health Care Coverage Fathers
Who Do Not Provide Health Care Coverage
to Their Nonresident Children at Any Point in the First Four Months of 1993
  Nonresident Father Income Level
<200% Poverty 200% Poverty+ Total
Total 3,862,568 4,137,132 7,999,700
Has Access to Dependent Coverage 722,071 2,291,778 3,013,849
Possibly Has Access to Dependent Coverage 316,156 480,527 796,683
Does Not Have Access to Dependent Coverage 2,824,341 1,364,828 4,189,168
Has Access 722,071 2,291,778 3,013,849
Has Dependent Coverage for Resident Family 288,848 1,017,984 1,306,832
Has Individual Coverage, Dependent Coverage Offered 433,223 1,273,794 1,707,017
Possibly Has Access (thousands) 316,156 480,527 796,683
Does Not Have Access (thousands) 2,824,341 1,364,828 4,189,168
Has Individual Coverage, Dependent Not Offered 133,903 197,680 331,583
Not Covered, Firm Offers Individual Coverage 25,666 32,808 58,474
Not Covered, Firm Doesn't Offer Any Coverage 695,428 522,744 1,218,172
Self-Employed 159,158 242,947 402,105
Not Working 1,203,992 368,648 1,572,640
Incarcerated 606,194   606,194
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.7:
Nonresident Fathers' Work and Health Care Coverage Status Throughout the Year
By Whether or Not They Provide Health Care Coverage
to Their Nonresident Children in at Least One Month of the Year
  Providers Nonproviders, By Income Level Total
Total Total <200% Poverty 200% Poverty +
Total 3,097,306 7,129,539 3,723,409 3,406,130 10,226,845
Percentage Working
All Months 2,814,855 3,574,631 1,029,562 2,545,069 6,389,486
Some Months 248,047 1,658,781 1,078,955 579,826 1,906,828
No Months 34,404 1,896,127 1,614,892 281,235 1,930,531
Percentage Covered in Own Name
All Months 2,660,395 1,851,649 369,246 1,482,403 4,512,044
Some Months 416,980 1,327,667 615,170 712,497 1,744,647
No Months 19,932 3,950,223 2,738,993 1,211,230 3,970,155
Percentage Covering Nonresident Children
All Months 1,377,091 - - - 1,377,091
Some Months 1,720,216 - - - 1,720,216
No Months - 7,129,539 3,723,409 3,406,130 7,129,539
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.8:
Continuity of Access to Health Care Coverage by Children in Custodial Families
  Custodial Family Income
<200% of Poverty 200% Poverty+ Total
Families Where Father Provides Health Care Coverage in at Least One Month 1,355,758 1,070,510 2,426,268
Covered by Father in Every Month of Year 536,062 490,950 1,027,012
Gain and Keep Coverage from Father 314,912 186,854 501,765
Lose and Don't Regain Coverage from Father 202,269 229,358 431,627
Gain and Lose or Lose and Regain Coverage in Year 302,515 163,348 465,863
Families Gaining Health Care Coverage from the Father During the Year 617,427 350,202 967,629
Covered by Custodial Family in Prior Month 208,963 300,252 509,216
Medicaid/Medicare Coverage in Prior Month 205,475 10,755 216,231
Uninsured in Prior Month 202,988 39,194 242,182
Families Losing Health Care Coverage from the Father During the Year 504,785 392,706 897,491
Covered by Custodial Family in Following Month 107,958 352,293 460,251
Medicaid/Medicare Coverage in Following Month 180,777 0 180,777
Uninsured in Following Month 216,049 40,413 256,462
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.9:
Child Support and Health Care Coverage, By Location of the Nonresident Father
  Custodial Family Income
<200% Poverty 200% Poverty+ Total
All Custodial Families 6,636,496 3,590,516 10,226,142
Location of Nonresident Father
Same City/County 2,873,156 1,385,014 4,258,169
Elsewhere in State 1,255,596 906,168 2,161,764
Different State 1,196,901 770,692 1,967,593
Other 383,160 152,641 535,801
Don't Know 927,683 376,001 1,303,685
Number Receiving Child Support in at Least One Month of the Year
Father in Same State 2,072,542 1,475,324 3,547,866
Father in Different State 454,100 411,270 865,370
Number Receiving Health Care Coverage From Father in at Least One Month of the Year
Father in Same State 1,008,294 840,351 1,848,646
Father in Different State 262,697 182,859 445,556
Source: Author's analysis of the 1993 Survey of Income and Program Participation.

Table C.10:
Provision for Health Costs, By Location of the Nonresident Father
Custodial Families with an Award or Written Agreement Provision for Health Costs in the Child Support Award or Agreement Total
Nonresident Father to Provide Health Care Coverage Custodial Family to Provide Health Care Coverage Other Provision For Health Costs No Provision for Health Costs
Total* 1,908,399 800,119 442,127 1,951,155 5,101,800
Location of Nonresident Father
Same State 1,428,804 578,124 303,323 1,285,652 3,595,903
Different State 393,935 158,065 101,245 470,718 1,123,963
Custodial Families <200% Poverty* 1,062,170 320,443 248,378 1,226,656 2,857,647
Location of Nonresident Father
Same State 803,779 237,566 174,618 855,748 2,071,711
Different State 210,276 67,745 61,915 249,499 589,435
Custodial Families 200% Poverty+* 846,229 479,676 193,749 724,499 2,244,153
Location of Nonresident Father
Same State 625,025 340,559 128,704 429,904 1,524,192
Different State 183,659 90,320 39,330 221,218 534,527
* The total includes a small number of fathers living outside the United States and some whose location is unknown.

Source: Author's analysis of the 1993 Survey of Income and Program Participation.

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Appendix D:
Impact of Additional Coverage, by Race and Child Support Status

The comparison presented in Table 6 can be extended to groups defined by race and payment and receipt of child support, since the number of nonresident fathers closely matches the number of custodial mothers by these characteristics. As shown in Table D.1, groups with the lowest provision of private health care coverage by custodial families also have the lowest potential for provision by nonresident fathers. For example, custodial families who do not receive child support are less likely to provide health care coverage than are families who receive child support, and nonresident fathers who do not pay child support are less likely to be able to provide health care coverage than are those who pay. Thirty-five percent of custodial families who do not receive child support and do not receive health care coverage from the nonresident father provide health care coverage themselves, compared to 49 percent of custodial families who receive child support and do not receive health care coverage from the nonresident father. Between 34 and 44 percent of nonresident fathers who do not pay child support and do not provide health care coverage are estimated to have access to dependent coverage, compared to between 54 and 63 percent of nonresident fathers who pay child support and do not provide health care coverage.
Table D.1:
Potential for Coverage by Race and Payment/Receipt of Child Support Custodial Families Who Do Not Receive Health Care Coverage from the Nonresident Father in the First Four Months of 1993
  Total
(Thousands)
Overlapping Groups*
Percent with Private Coverage from Custodial Family Percent Where Nonresident Father Has Access to Coverage
Total Custodial Families Not Receiving Health Care Coverage from the Nonresident Father 8,562 41% 42% - 51%
By Receipt of Child Support
Receives Child Support 3,432 49% 54% - 63%
Does Not Receive 5,130 35% 34% - 44%
By Race
Black** 2,753 33% 39% - 46%
Nonblack 5,809 45% 43% - 54%
By Race and Receipt of Child Support
Black, Receives Support 889 NA*** NA***
Black, Does Not Receive 1,864 32% 26% - 34%
Nonblack, Receives 2,543 55% 51% - 61%
Nonblack, Does Not Receive 3,266 37% 38% - 49%
* The extent to which custodial families providing health care coverage to their children overlap with custodial families in which the nonresident father has access to health care coverage cannot be ascertained from this data.

** Black Hispanics are included in the Black category.

*** Sample size is insufficient for reliable estimates.

Source: Author's Analysis of the 1993 Survey of Income and Program Participation.

The pattern also holds true by race, although the difference between blacks and nonblacks is slightly less pronounced than the difference between those who pay or receive child support and those who do not. Black custodial families are less likely to provide health care coverage than are nonblack custodial families, and black nonresident fathers are less likely to be able to provide health care coverage than are nonblack nonresident fathers. Thirty-three percent of black custodial families and 45 percent of nonblack custodial families not receiving health care coverage from the nonresident father provide coverage themselves, and between 39 and 46 percent of black nonresident fathers and 43 and 54 percent of nonblack nonresident fathers not providing health care coverage are estimated to have access to dependent coverage.

When both race and payment or receipt of child support are controlled for, the difference between groups becomes even more pronounced. Of custodial families who do not receive health care coverage from the nonresident father, 32 percent of black custodial families who do not receive child support provide health care coverage themselves, compared to 37 percent of nonblack custodial families who do not receive child support, and 55 percent of nonblack families who receive child support. (An estimate for black child support recipients is unavailable, due to sample size restrictions.) As before, the groups in which custodial families are least likely to provide health care coverage correspond to the groups in which nonresident fathers are the least likely to have access to dependent coverage. Between 26 and 34 percent of black nonresident fathers who do not pay child support and do not provide health care coverage are estimated to have access to dependent coverage, compared to between 38 and 49 percent of nonblack nonresident fathers who do not pay child support and do not provide health care coverage, and between 51 and 61 percent of nonblack nonresident fathers who pay child support but do not provide health care coverage.

It is reasonable to expect a fair amount of overlap between custodial families who provide private health care coverage and nonresident fathers who are able to provide coverage but do not. Assuming that women tend to partner with men of a similar or higher socioeconomic status, a custodial family that is able to provide private health care coverage probably has a nonresident father who could do the same. Furthermore, the very reason that a nonresident father might not provide health care coverage is that the children are better off covered under the custodial family's health care plan. To the extent these two groups overlap, the potential for further reductions in Medicaid utilization and the number of uninsured is limited.


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Updated 8/4/00