Get access

Income Eligibility Thresholds, Premium Contributions, and Children's Coverage Outcomes: A Study of CHIP Expansions

Authors

  • Carole Roan Gresenz Ph.D.,

    Corresponding author
    1. Department of Health Systems Administration, Georgetown University, Washington, DC
    • Address correspondence to Carole Roan Gresenz, Ph.D., Department of Health Systems Administration, Georgetown University, 3700 Reservoir Road, NW, Washington, DC 20057; e-mail: crg70@georgetown.edu.

    Search for more papers by this author
  • Sarah E. Edgington M.A.,

    1. Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
    Search for more papers by this author
  • Miriam J. Laugesen Ph.D.,

    1. Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, NY
    Search for more papers by this author
  • José J. Escarce M.D., Ph.D.

    1. Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
    2. RAND Corporation, Santa Monica, CA
    Search for more papers by this author

Abstract

Objective

To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children.

Data Sources

2002–2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources.

Study Design

We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line.

Principal Findings

Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules).

Conclusions

Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable.

Get access to the full text of this article

Ancillary