The magnitude of crowd-out, the substitution of public coverage for private insurance, is of interest to policymakers as states extend eligibility for publicly-funded health insurance to higher income children. We investigated whether participation in a state publicly-financed health insurance program, Massachusetts Children's Medical Security Plan (CMSP), which is open to children regardless of income, was associated with disenrollment from private insurance. We surveyed parents of CMSP participants. The sampling strategy allowed us to examine crowd-out among children based on income and eligibility for publicly-funded coverage. We conducted analyses to detect differences in access to and uptake of private insurance between Medicaid-eligible and not eligible children, and between SCHIP-eligible and not eligible children. At the time of enrollment, 11% of the children in our sample were insured, 24% previously had insurance but had been uninsured for < 6 months, 41% previously had insurance but had been uninsured for > 6 months, and 24% never had coverage. The most common reason for loss of coverage among those previously insured was parental job change (66%). We found little substitution of public coverage for private insurance, even among CMSP enrollees with incomes >200% FPL, due to limited access to employer insurance (22%) and low insurance uptake (27%). The Massachusetts experience suggests that 1) coverage could be expanded to children with incomes up to 200% FPL with very little direct substitution of public coverage for private insurance and 2) the premiums required of children with incomes >200% FPL may have restrained crowd-out in this income group.
Learning Objectives:
Keywords: Access to Care, Health Insurance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.