Crowd out: evidence from the Florida Healthy Kids Program.
OBJECTIVE
To determine the percentage of children who had insurance coverage in the 12 months preceding enrollment in a state-subsidized program; the percentage of parents who had access to employer-based family coverage; and the cost of the families' share of the premium per month.


METHODS
We randomly selected 930 families whose children were enrolled in the Florida Healthy Kids Program for a period of between 1 and 3 months and conducted telephone interviews with them in 1998 about their children's insurance coverage before program entry and their access to employer-based family coverage. There were 653 families in the final sample.


RESULTS
Only 5% of the children had employer-based coverage before program enrollment. However, 26% had access to family coverage through their employers with the family share of the premiums representing on average 13% of their incomes. Access to employer-based coverage varied significantly by family income.


CONCLUSIONS
Throughout the development of the State Children's Health Insurance Program legislation, policy analysts expressed concern that families may crowd out or substitute a subsidized state plan for employer-based coverage. This substitution could result in fewer improvements in access to care and health status than were anticipated, because families are simply moving to a different form of health insurance. There is some degree of crowd out in the Healthy Kids Program. The economic burden to near-poor families to purchase employer-based coverage is significant. Some degree of substitution may need to be tolerated to ensure that children receive needed health insurance.
Shenkman
E
E
Institute for Child Health Policy, University of Florida, Gainesville 32608, USA. eas@ichp.edu
Bucciarelli
R
R
Wegener
D H
DH
Naff
R
R
Freedman
S
S
D002648:Child; D003365:Costs and Cost Analysis; D005260:Female; D005431:Florida; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs; D017057:Medically Uninsured / Q000706:statistics & numerical data; D017149:Private Sector; D017150:Public Sector; D013221:State Health Plans / Q000191:economics / Q000706:statistics & numerical data; D014481:United States