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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Emily Feinberg, Sc D and Rebecca E. Goldstein, ScM. Bureau of Family and Community Health, Massachusetts Department of Public Health, 250 Washington Street 5th Floor, Boston, MA 02108, 617-624-6039, feinberge@aol.com
The insurance characteristics of higher income children are of interest to policy makers as states evaluate expanding eligibility to SCHIP programs. We investigated whether participation in a state publicly-financed health insurance program, Massachusetts Children's Medical Security Plan (CMSP), which enrolls children whose family income exceeds the state’s Medicaid/SCHIP eligibility criteria, was associated with disenrollment from private insurance. The study used data from a 2000 survey of 750 CMSP participants with family incomes > 200% of the federal poverty limit (FPL). We conducted analyses to identify factors associated with access to and uptake of private insurance and to estimate the amount of direct substitution of public coverage for private insurance. At the time of enrollment, 10% of the children in our sample had some type of private insurance, 13% were in the process of transitioning from Medicaid to CMSP, 53% were previously insured but had been uninsured for < 6 months, 16% previously had insurance but had been uninsured for > 6 months, and 8% never had coverage. Of the children whose most recent health care coverage was employer-sponsored insurance (ESI) (42%), more than 75% were no longer eligible. A change in family employment was the primary reason for loss of coverage. Compared to children whose most recent insurance was Medicaid, enrollees with previous ESI were also significantly more likely to be uninsured for > 6 months. Because the families of more than half of children who had ESI at enrollment maintained dual coverage for longer than 3 months, we calculated 2 measures of crowd out. The first included the dual-coverage children (assuming that they would have dropped their private coverage to enroll in CMSP), and the second excluded them. This approach provided an upper (9%) and lower (4%) bound for our estimate of crowd out. Access to ESI was limited (34%) and uptake was low (27%). Higher income children with previous ESI remained on the program for relatively short intervals (43% disenrolled within a year). About two thirds of these children re-enrolled in ESI. They were significantly more likely than children who had never been covered by ESI to obtain this type of coverage. We found a relatively low level of direct substitution of public coverage for private insurance in this population of children with incomes >200% FPL. The program’s modest premiums and a less comprehensive benefit package than customary under employment-based insurance may have restrained crowd-out. Findings are consistent with other studies based on survey responses and longitudinal analyses.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to
Keywords: Health Insurance, Access to Care
Presenting author's disclosure statement:
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.