Venue: The Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0120
Presentation
The Effects of Programmatic Features of Medicaid/SCHIP on Transitions from Private Insurance Coverage among U.S. Low-Income Children: A Dynamic Approach
Problem Statement: Prior studies have shown that earlier Medicaid expansions and the more recent implementation of the expanded Medicaid/SCHIP have significantly increased public program participation and have reduced the number of uninsured individuals. However, empirical evidence indicates that the reduction in the number of uninsured has been offset by declines in private insurance coverage. Also, studies have suggested that the different forms of state Medicaid/SCHIP programs, that is, stand-alone SCHIP programs, expanded Medicaid, and a combination of both have different impacts on public and private health insurance coverage.
The objective of this paper is to examine the effects of the different forms of states' Medicaid/SCHIP programs on transitions from private insurance coverage among American low-income children.
The study will attempt to answer questions such as (1) did the post-1996 welfare reform states' Medicaid/SCHIP program expansions cause transitions from private insurance among sampled low-income children?; (2) how did the different forms of states' Medicaid/SCHIP programs affect the likelihood of transition from private insurance coverage?; and (3) are waiting periods effective in reducing the likelihood of transitions from private coverage?
Methods: I am employing event history analysis and multilevel modeling techniques to analyze data from the 2001 panel of the Survey of Income and Program Participation (SIPP), which covers the period 2001 to 2004. The combined approach will estimate discrete-time logistic regression models. Outcome variables being modeled are low-income children's transitions from private insurance coverage to: (1) Medicaid/SCHIP; and (2) being uninsured. State-level data from a variety of sources will be appended to the SIPP data set. The analytic sample for the study consists of unmarried children, nineteen years old or younger, living in families with incomes at or below 350 percent of the federal poverty level (FPL).
Expected Results: Based on prior studies and preliminary analysis, expanded Medicaid programs, relative to stand-alone SCHIP programs are more likely to increase transitions from private to public insurance, while longer waiting periods are expected to reduce transitions from private insurance.
Significance of Study: This paper will contribute to existing literature and policy in the following important ways:
(A) Most previous studies used cross-sectional data to examine health insurance coverage without analyzing actual transitions from one type of insurance coverage to another or accounting for differences across states. The combined use of event history analysis and multi-level modeling approach incorporates the timing of transitions from private insurance and also accounts for cross-state differences in transition rates. The estimation method being used is the generalized linear mixed procedure, which is designed to fit statistical models to data with correlations and heteroskedasticity.
(B) Results from this study could inform policy debates on how the different forms of states? Medicaid/SCHIP programs can be modified to achieve greater reductions in the number of uninsured children, while simultaneously reducing crowd-out of private insurance as necessary.