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The effects of state policy design features on take-up and crowd-out rates for the state children's health insurance program

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Author Info

  • Cynthia Bansak

    (San Diego State University)

  • Steven Raphael

    (University of California Berkeley)

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    Abstract

    We evaluate the effects of state policy design features on SCHIP take-up rates and on the degree to which SCHIP benefits crowd out private benefits. The results indicate overall program take-up rates of approximately 10 percent. However, there is considerable heterogeneity across states, suggesting a potential role of inter-state variation in policy design. We find that several design mechanisms have significant and substantial positive effects on take-up. For example, eliminating asset tests, offering continuous coverage, simplifying the application and renewal processes, and extending benefits to parents all have sizable and positive effects on take-up rates. Mandatory waiting periods, on the other hand, consistently reduce take-up rates. In all, inter-state differences in outreach and anti-crowd-out efforts explain roughly one-quarter of the crossstate variation in take-up rates. Concerning the crowding out of private health insurance benefits, we find that between one-quarter and one-third of the increase in public health insurance coverage for SCHIP-eligible children is offset by a decline in private health coverage. We find little evidence that the policy-induced variation in take-up is associated with a significant degree of crowd out, and no evidence that the negative effect on private coverage caused by state policy choices is any greater than the overall crowding-out effect. This suggests that states are not augmenting take-up rates by enrolling children that are relatively more likely to have private health insurance benefits. © 2006 by the Association for Public Policy Analysis and Management.

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    File URL: http://hdl.handle.net/10.1002/pam.20231
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Journal of Policy Analysis and Management.

    Volume (Year): 26 (2007)
    Issue (Month): 1 ()
    Pages: 149-175

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    Handle: RePEc:wly:jpamgt:v:26:y:2007:i:1:p:149-175

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    Web page: http://www3.interscience.wiley.com/journal/34787/home

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    References

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    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
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    1. Anna Aizer, 2003. "Got Health? Advertising, Medicaid and Child Health," Working Papers 2003-20, Brown University, Department of Economics.
    2. Barbara Wolfe & Scott Scrivner, 2005. "The devil may be in the details: How the characteristics of SCHIP programs affect take-up," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 24(3), pages 499-522.
    3. Lara D. Shore-Sheppard & John C. Ham, 2003. "The Effect of Medicaid Expansions for Low-Income Children on Medicaid Participation and Private Insurance Coverage : Evidence from the SIPP," Department of Economics Working Papers 2003-10, Department of Economics, Williams College.
    4. Anthony T. LoSasso & Thomas C. Buchmueller, 2002. "The Effect of the State Children's Health Insurance Program on Health Insurance Coverage," NBER Working Papers 9405, National Bureau of Economic Research, Inc.
    5. Wojciech Kopczuk & Cristian Pop-Eleches, 2005. "Electronic Filing, Tax Preparers, and Participation in the Earned Income Tax Credit," NBER Working Papers 11768, National Bureau of Economic Research, Inc.
    6. Mark C. Berger & Dan A. Black & Frank A. Scott, 1998. "How Well Do We Measure Employer-Provided Health Insurance Coverage?," Contemporary Economic Policy, Western Economic Association International, vol. 16(3), pages 356-367, 07.
    7. Shore-Sheppard, Lara & Buchmueller, Thomas C. & Jensen, Gail A., 2000. "Medicaid and crowding out of private insurance: a re-examination using firm level data," Journal of Health Economics, Elsevier, vol. 19(1), pages 61-91, January.
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    Cited by:
    1. Stephanie Riegg Cellini, 2009. "Crowded Colleges and College Crowd-Out: The Impact of Public Subsidies on the Two-Year College Market," American Economic Journal: Economic Policy, American Economic Association, vol. 1(2), pages 1-30, August.
    2. Sean Orzol & Linda Barterian & Michael Barna, 2012. "Proven Strategies in Health Care Coverage Program Outreach and Enrollment," Mathematica Policy Research Reports 7819, Mathematica Policy Research.

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