July 2008

Grant Results

National Program

Changes in Health Care Financing and Organization

SUMMARY

In this 2003 to 2005 project, researchers from the Urban Institute examined the dynamics of health insurance coverage and public health insurance eligibility from 1996 to 2000 and assessed the impact of public policy and economic changes on coverage.

Their analysis included enrollment in the State Children's Health Insurance Program (SCHIP) to determine whether increases in program participation reflected access to new coverage or substitution of public coverage for private.

This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO) (for more information see Grant Results). HCFO supports policy analysis, research, evaluation and demonstration projects that provide public and private decision leaders with usable and timely information on health care policy and financing issues.

Key Findings

The researchers reported the following findings in the Findings Brief:

  • There is minimal evidence that eligibility for public health insurance produced substantial reductions in private coverage and compelling evidence of decreases in uninsurance.
  • Children who were uninsured but became eligible for public health insurance through SCHIP were likely to have remained uninsured if not for SCHIP implementation.

Funding

RWJF provided a $527,060 grant for the project from 2003 to 2005.

 See Grant Detail & Contact Information
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THE PROJECT

The period between 1996 and 2000 was characterized by the implementation of national welfare reform and the State Children's Health Insurance Program (SCHIP) and an economic boom. In this 2003 to 2005 project, Linda J. Blumberg, Ph.D., and Lisa C. Dubay, Ph.D., of the Urban Institute examined the dynamics of health insurance coverage and public health insurance eligibility during this period and assessed the impact of public policy and economic changes on insurance coverage.

The Urban Institute, based in Washington, gathers and analyzes data, conducts policy research, evaluates programs and services and educates Americans on critical issues and trends.

The Main Study

In the main part of the study, the researchers studied SCHIP enrollment patterns to determine whether increases in program participation reflected access to new coverage or substitution of public coverage for private. They used the 1996 panel of the U.S. Census Bureau's Survey of Income and Program Participation and the Urban Institute's Transfer Income Model Version 3 (a microsimulation model) for this and four other analyses. See the Appendix for more information about study methodology.

Other Analyses

As part of the project, the researchers conducted other analyses:

  • Health Insurance Coverage Dynamics Among Children and Non-elderly Adults, 1996–99
  • Dynamics in Medicaid and SCHIP Eligibility Among Children: 1996–2000
  • Participation in Public Health Insurance Programs in the Wake of Welfare Reform and SCHIP Implementation
  • Did the Economic Boom Increase Insurance Coverage for Low Income-Uninsured Adults? An Analysis Using the 1996–2000 Survey of Income and Program Participation

Communications

In addition to the HCFO Findings Brief, the researchers published one article in Health Affairs and provided another paper to the Congressional Budget Office to inform its analysis of SCHIP. See the Bibliography for details.

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FINDINGS

Researchers reported the following findings in the Findings Brief (June 2006):

  • There is minimal evidence that public health insurance coverage eligibility produced substantial reductions in private coverage and compelling evidence of decreases in uninsurance:
    • Nearly three-quarters of enrollment increases could be attributed to a reduction in uninsurance, while a quarter of recipients substituted public insurance for private insurance.
    • There was no evidence of crowd-out (when expanded public health insurance coverage "crowds out" private health insurance):
      • SCHIP had virtually no effect on children's movement from private to public coverage. In fact, private coverage among SCHIP-eligible children rose 8 percent — to 69 percent.
    • The greatest increases in SCHIP coverage were among children who had the lowest incomes at the beginning of the survey, suggesting that the program was appropriately used by people with few other options for coverage.
    • The likelihood of SCHIP-eligible children remaining covered by public health insurance increased 14 percent.
  • Children who were uninsured at the beginning of the survey but became eligible for public health insurance through SCHIP were likely to have remained uninsured if not for SCHIP implementation:
    • By 2000, SCHIP-eligible children were 10 percent more likely to have public coverage and 9.6 percent less likely to remain uninsured than were near-eligible children.

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GRANT DETAILS & CONTACT INFORMATION

Project

Dynamics of Health Insurance Coverage From 1996 to 2000

Grantee

Urban Institute (Washington,  DC)

  • Amount: $ 527,060
    Dates: September 2003 to October 2005
    ID#:  049257

Contact

Linda J. Blumberg, Ph.D.
(202) 261-5769
lblumber@ui.urban.org

Web Site

http://www.hcfo.net/about.htm

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APPENDICES


Appendix 1

Study Methodology

The study used the following surveys:

The U.S. Census Bureau's 1996 Survey of Income and Program Participation
This survey gathered information on labor force participation, income levels, public program participation and health insurance coverage from a nationally representative sample of the U.S. civilian, noninstitutionalized population. Participants were asked to report whether their health coverage was Medicaid or SCHIP, employer-sponsored insurance or military coverage, private non-group or private coverage of an unknown type or whether they were uninsured.

The Transfer Income Model Version 3
This model simulates the major governmental tax, transfer and health programs that affect the U.S. population. The Urban Institute developed and maintains it. The Department of Health and Human Services provides primary funding for the model.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Dubay L and Blumberg LJ. "The Impact of SCHIP on Insurance Coverage of Children in Its Infancy: An Analysis Using the SIPP." Unpublished.

Sommers AS, Dubay L, Blumberg LJ, Blavin FE and Czajka JL. "Dynamics in Medicaid and SCHIP Eligibility Among Children in SCHIP's Early Years: Implications for Reauthorization." Health Affairs, 26(5): 598–607, 2007.

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Report prepared by: Barbara Matacera Barr
Reviewed by: Lori De Milto
Reviewed by: Molly McKaughan
Program Officer: Nancy Barrand

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