Does a Patchwork Approach to Health Insurance Expansion Exacerbate Public Insurance Drop-Out?

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• Does a Patchwork Approach to Health Insurance
  Expansion Exacerbate Public Insurance Drop-Out?

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Background Children Without Health Insurance
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Conceptual Framework Why Do Kids Disenroll?
Parents must reenroll annually to prove
eligibility. Why might they not do so?

• ? Acquiring Other Health Insurance
• ? Loss of Eligibility
• ? Drop-Out Uninsured Still Eligible

- Only drop-out is a program failure.
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Motivation Objectives
Incrementalism is the current approach to
health insurance expansion Does this
exacerbate the drop-out problem?
Question 1 Do separate CHIP's (vs. combined
Mcaid/CHIP programs) fare differently in
retention? Question 2 Does covering parents
improve the retention of children?
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Is This A Problem?
Mom Dad need not apply... Is this Medicaid,
CHIP, or both?
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Data Methods

• Child household data from the CPS March
  Supplement (2000-2004), using two-year linked
  samples
• Since 2001, CPS asks about CHIP separately from
  Medicaid
• State-specific eligibility rules from the
  National Governors Association
• State policies for Medicaid/CHIP from state
  welfare offices and previous studies

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Results Key Descriptive Statistics

• As of 2001, 17 states D.C. ran combined
  CHIP/Medicaid programs, and 33 ran separate
  CHIP's.
• 23 of CHIP kids had a parent in public
  insurance, vs. 61 of Medicaid kids
• Roughly 2 million children switched back forth
  between Medicaid CHIP each year
• Drop-Out CHIP 15.6 , Medicaid 12.5

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Effect of Combined vs. Separate Medicaid/CHIP
Program on Drop-Out
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Effect of Family Coverage in Medicaid on Drop-Out
Among Children

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Limitations

• Correlational only, for the combined vs. separate
  programs
• 12 month snapshots dont let us see
• How long children stay enrolled
• If drop-outs ever return to Medicaid
• Technical issues for CPS data
• Medicaid /CHIP Undercount
• Monthly vs. Annual Income Data
• Attrition Bias

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Policy Implications
Separate programs are administratively costly (2
million kids switching annually) and exacerbate
drop-out ? States should consider combining
Medicaid CHIP, or at least streamline
transitions between programs. Covering parents
and kids separately doesnt make sense in terms
of retention ? Cover families, not individuals.
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Acknowledgments
This research was conducted with the support of a
fellowship from the National Science
Foundation. Many thanks to Joe Newhouse, David
Cutler, Kathy Swartz, and Melissa Wachterman for
excellent advice throughout this project.