title: Public-private substitution among Medicaid adults: evidence from Ohio.
abstract: OBJECTIVE To estimate substitution from private insurance to public coverage among adult Medicaid  enrollees.
  
  
  METHODS
  2004 and 2008 Ohio Family Health Surveys (OFHS) STUDY DESIGN: Substitution is estimated from  respondents' self-reported current insurance coverage and coverage prior to Medicaid enrollment. A linear probability  model estimates the association between prior private coverage and respondent characteristics.
  
  
  METHODS
  Random digit dialing telephone survey of 50,944 Ohio residents in 2008-2009 and  39,953 in 2003-2004.
  
  
  RESULTS
  Few adult Medicaid enrollees in Ohio voluntarily replace their private  coverage with Medicaid. In 2008, only 2.9% of new Medicaid adults voluntarily substituted public for private coverage  (4.6% in 2004). Of these 2.9% who voluntarily substituted from private to public coverage, 38% reported that they  could not afford their employer sponsored plan. The multivariate results for all private to Medicaid transitions find  few significant differences, other than income, in the probability of transition.
  
  
  CONCLUSIONS
  Few transitions from  private coverage to Medicaid are voluntary, and substitution is a minor issue among current Ohio Medicaid adults.
authors.affiliation: Ohio State University-College of Public Health, Columbus, OH 43210, USA. seiber.7@osu.edu
authors.forename: Eric E
authors.initials: EE
authors.lastname: Seiber
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Sahr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003625:Data Collection; D004608:Eligibility Determination; D005260:Female; D006264:Health Benefit Plans, Employee / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D014481:United States; D055815:Young Adult