title: Children's health insurance and access to care during and after the CHIP expansion period.
abstract: OBJECTIVE
  We used national data from the Medical Expenditure Panel Survey and multivariate linear spline regression models to compare trends in children's health insurance coverage and access to care by income and race/ethnicity during (1998-2002) and after (2002-2006) major expansions of state insurance programs.
  
  
  RESULTS
  During expansions, coverage and access for children in low-income and middle-income families improved, but these gains ceased thereafter for middle-income children, most of whom remained ineligible for public insurance. Racial and ethnic differences narrowed from 1998-2002, but persisted-and in at least one case tended to widen-from 2002-2006. Non-White children in families with incomes above most states' eligibility thresholds experienced significant declines in coverage and access to care after 2002.
  
  
  CONCLUSIONS
  Gains in children's coverage and access to care during CHIP expansions have since stagnated or even reversed for some groups. Recent legislation to expand coverage for uninsured children (the PPACA of 2010) may redress these adverse changes in trends.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: Miji
authors.initials: M
authors.lastname: Choi
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.forename: J Michael
authors.initials: JM
authors.lastname: McWilliams
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D004608:Eligibility Determination; D005006:Ethnicity / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data / Q000639:trends*; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D019458:Insurance Coverage / Q000706:statistics & numerical data / Q000639:trends*; D007348:Insurance, Health / Q000706:statistics & numerical data / Q000639:trends*; D017057:Medically Uninsured / Q000331:legislation & jurisprudence; D015397:Program Evaluation; D013221:State Health Plans; D014481:United States