Russo G, Lee SH, Nitz L, Lekprichakul T; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1005.
University of Hawaii, Department of Economics, 2424 Maile Way, Saunders Hall 542, Honolulu, HI 96822 Tel. 808.956.7065 Fax 808.956.4347
RESEARCH OBJECTIVE: The purpose of this study is two-fold. First, to assess the impact of the initial SCHIP expansion which occurred in Hawaii July 1, 2000 and extended free public insurance coverage to all children aged 0-18 years residing in households with incomes not greater than 200% of the Hawaii specific federal poverty level, FPL. Second, to predict take-up of public coverage and crowd-out of private insurance which may occur under a proposed expansion of eligibility to children aged 0-18 years residing in households with incomes between 200% and 300% of the federal poverty level FPL. STUDY DESIGN: This study exploits the natural experiment of a July 1, 2000 SCHIP expansion, which is reflected in survey data, to estimate take-up and crowd-rates among newly eligible beneficiaries. Prior to the implementation of SCHIP, children in Hawaii were eligible for free medical assistance under Medicaid financing per the following age-income criteria. Children age 0 were eligible up to 185% of the Hawaii specific FPL, children aged 1-5 years up to 133% FPL and children aged 6-18 years up to 100% of the FPL. On July 1, 2000, SCHIP was implemented in Hawaii as a Medicaid expansion and extended coverage to all children age 0-18 up to 200% FPL. Thus, children under age 1 residing in families with incomes between 186% and 200% FPL, children age 1-5 in families with incomes between 134% and 200% FPL and children age 6-18 in families with incomes between 101% and 200% became newly eligible for free medical assistance under SCHIP July 1, 2000. This treatment group is tracked in 1998-1999 before eligibility and in 2001-2002 after eligibility and both direct and model-based estimates of insurance status are produced. Children aged 0-18 years residing in families with incomes between 201% and 250% the FPL have been ineligible for public insurance throughout the period 1998-2002 and are used as a control group. The study uses a difference-in-difference approach to sweep out non-policy related effects. Estimates are based on multiple years of the Hawaii Health Survey, confidential version and the Current Population Survey, Annual Social and Economic Supplement, public use version. Model-based estimates are also used to project a response to increased eligibility up to 300% of the FPL. POPULATION STUDIED: The study is exclusive to Hawaii residents aged 0-18 years residing in households with incomes between 0% and 300% of the Hawaii specific federal poverty guidelines as published by the U.S. Department of Health and Human Services. Weighted population estimates are produced using the Hawaii Health Survey 1998-2002 and the Hawaii sample of Current Population Survey 1998-2003. Three groups are analyzed, children eligible for free public insurance throughout the period, children who began the period ineligible and became eligible in 2000 and children who were ineligible throughout the period. PRINCIPAL FINDINGS: The Initial SCHIP implementation of July 1, 2000, which brought public insurance eligibility to 200% FPL, enrolled approximately 6000-7000 children with rather modest displacement of private insurance. The proposed further expansion to 300%, however, is projected to generate dramatic crowd-out as households drop private family coverage to enroll children in free public insurance. Preliminary model-based estimates predict 29,000 new children enrollees coming from households with incomes between 201% and 300% of the FPL. Of these only 2000 would have been previously uninsured, while 27,000 would be drawn from private insured families--a staggering rate of crowd-out. CONCLUSIONS: Because of a number of factors, including Hawaii's Pre-paid Health Care Act of 1974, which mandates private sector employment-based coverage, middle-class families are typically well insured. Of the approximately 50,000-55,000 children aged 0-18 years residing in families with incomes between 201% and 300% of the FPL, only 2000-3000 are without health insurance coverage. As a result, a generous public expansion which takes all comers up to 300% FPL is likely to yield a large number of privately insured along with the uninsured. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: A Hawaii SCHIP expansion to 300% of the FPL will result in substantial crowd-out of private insurance. Whether viewed from the broad federal perspective or the narrow state budgetary perspective, such an expansion would generate high public expenditures per newly insured child and should therefore be pursued with caution. A successful and sustainable expansion of eligibility criteria must be accompanied by safeguards against excessive private insurance crowd-out.
Publication Types:
Keywords:
- Child
- Child Health Services
- Eligibility Determination
- Family
- Family Characteristics
- Fees and Charges
- Hawaii
- Health Expenditures
- Humans
- Income
- Insurance Coverage
- Insurance, Health
- Medicaid
- Medical Assistance
- Medically Uninsured
- Poverty
- Private Sector
- economics
- hsrmtgs
UI: 103624039
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