Recorded presentation

Sharon K Long, PhD¹, Stephen Zuckerman, PhD², and John Graves, BA¹. (1) Health Policy Center, The Urban Institute, 2100 M Street, NW, Washington, DC 20037, (2) Health Policy Center, Urban Institute, 2100 M Street, NW, Washington, DC 20037, 202-261-5679, szuckerm@ui.urban.org

The biggest change in public health insurance during the past decade was the State Children’s Health Insurance Program (SCHIP). As SCHIP was getting started in every state, a small number of states implemented major expansions of public coverage for adults. Some states focused on the parents of children eligible for Medicaid and SCHIP, while others expanded coverage to all types of low-income adults. Moreover, income eligibility standards varied across states. These public coverage expansions can also provide incentives to forego private coverage, making it is critical to consider the programs’ effects on enrollment and its net effects on overall coverage.

We estimate the program impacts on the rate of uninsurance and displacement of private coverage using a difference-in-differences (DD) framework that compares changes in coverage among eligible adults in the states with expansions to adults with comparable characteristics in states without expansions. Such comparison groups provide the counterfactual for what would have happened if a state’s coverage rules had remained fixed. Because DD estimates may be sensitive to the choice of the comparison states, we draw on several different comparison groups to explore the robustness of our analysis. The comparison groups include adults who meet eligibility standards in each of the expansion states but reside in a state without an expansion.

We use data on low-income adults in the 1997, 1999 and 2002 rounds of the National Survey of America’s Families (NSAF), a nationally representative survey of the economic, health and social characteristics of children and non-aged adults. The survey oversamples families with incomes below 200 percent of the federal poverty level and families in 13 study states, including five of the states that have expanded coverage to adults (Massachusetts, New York, New Jersey, Wisconsin and California), and allows us to compare outcomes prior to and following the coverage expansions.

Our results will show the impact of each state program separately, because they are all somewhat different in terms of the policies they adopted and state demographics and, as such, need to be studied with different comparison groups. We applied similar methods to the 1997 and 1999 NSAF to show that MassHealth, the Massachusetts coverage expansion, reduced the share of low-income adults without insurance by nearly 30 percent. At the same time, there was little change in private insurance coverage, indicating that the MassHealth expansions led to only modest crowd out of employer-sponsored coverage.

Learning Objectives: At the conclusion of this presentation, the participant will be able to

• Identify the states that have expanded eligibility for public health insurance to adults.
• Evaluate the effectiveness of these expansions as a mechanism for increasing overall insurance coverage among adults.
• Assess the degree to which expansions in public coverage among adults are offset by reductions in private health insurance.

Keywords: Health Insurance, Medicaid

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.

Recorded presentation