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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

Author

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  • Cynthia Bansak

    (San Diego State University)

  • Steven Raphael

    (University of California Berkeley)

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.

Suggested Citation

  • Cynthia Bansak & Steven Raphael, 2007. "The effects of state policy design features on take-up and crowd-out rates for the state children's health insurance program," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 26(1), pages 149-175.
  • Handle: RePEc:wly:jpamgt:v:26:y:2007:i:1:p:149-175
    DOI: 10.1002/pam.20231
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    References listed on IDEAS

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    1. 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, July.
    2. Kopczuk, Wojciech & Pop-Eleches, Cristian, 2007. "Electronic filing, tax preparers and participation in the Earned Income Tax Credit," Journal of Public Economics, Elsevier, vol. 91(7-8), pages 1351-1367, August.
    3. 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.
    4. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, vol. 23(5), pages 1059-1082, September.
    5. Lara D. Shore-Sheppard, 2005. "Stemming the Tide? The Effect of Expanding Medicaid Eligibility on Health Insurance," NBER Working Papers 11091, National Bureau of Economic Research, Inc.
    6. 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.
    7. Anna Aizer, 2003. "Got Health? Advertising, Medicaid and Child Health," Working Papers 2003-20, Brown University, Department of Economics.
    8. Ham, John C. & Shore-Sheppard, Lara, 2005. "The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP," Journal of Public Economics, Elsevier, vol. 89(1), pages 57-83, January.
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    Cited by:

    1. James Marton & Angela Snyder & Mei Zhou, 2016. "Enhanced Citizenship Verification And Children'S Medicaid Coverage," Economic Inquiry, Western Economic Association International, vol. 54(3), pages 1670-1683, July.
    2. Andrea Brandolini & Silvia Magri & Timothy M. Smeeding, 2010. "Asset-based measurement of poverty," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 29(2), pages 267-284.
    3. Sean Orzol & Linda Barterian & Michael Barna, 2012. "Proven Strategies in Health Care Coverage Program Outreach and Enrollment," Mathematica Policy Research Reports 2f2980ef67654808b495e7782, Mathematica Policy Research.
    4. repec:mpr:mprres:7819 is not listed on IDEAS
    5. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters,in: Economics of Means-Tested Transfer Programs in the United States, volume 1, pages 21-136 National Bureau of Economic Research, Inc.
    6. Saavedra, Martin, 2017. "Children's health insurance, family income, and welfare enrollment," Children and Youth Services Review, Elsevier, vol. 73(C), pages 182-186.
    7. Bronchetti, Erin Todd, 2014. "Public insurance expansions and the health of immigrant and native children," Journal of Public Economics, Elsevier, vol. 120(C), pages 205-219.
    8. 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.

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