title: Income eligibility thresholds, premium contributions, and children's coverage outcomes: a study of CHIP expansions.
abstract: OBJECTIVE
  To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children.
  
  
  METHODS
  2002-2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources.
  
  
  METHODS
  We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line.
  
  
  RESULTS
  Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules).
  
  
  CONCLUSIONS
  Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable.
authors: Department of Health Systems Administration, Georgetown University, Washington, DC 20057, USA. crg70@georgetown.edu
authors: Carole Roan
authors: CR
authors: Gresenz
authors: Sarah E
authors: SE
authors: Edgington
authors: Miriam J
authors: MJ
authors: Laugesen
authors: José J
authors: JJ
authors: Escarce
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics*; D005191:Family Characteristics; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008483:Medical Assistance / Q000191:economics; D058991:Patient Protection and Affordable Care Act / Q000191:economics; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D014481:United States
references: Inquiry. 2005 Fall;42(3):232-54
references: 16353761
references: J Policy Anal Manage. 2007 Winter;26(1):149-75
references: 17312602
references: Health Aff (Millwood). 2007 Mar-Apr;26(2):529-37
references: 17339683
references: J Econ Soc Meas. 1986 Oct;14(3):233-42
references: 10285024
references: J Health Econ. 2004 Sep;23(5):1059-82
references: 15353193
references: Health Serv Res. 2012 Oct;47(5):1999-2011
references: 22515792
references: J Health Polit Policy Law. 2011 Oct;36(5):859-77
references: 21785010
references: Health Aff (Millwood). 2011 Dec;30(12):2371-81
references: 22147866
references: Inquiry. 2007 Summer;44(2):211-24
references: 17850046
references: Inquiry. 2006-2007 Winter;43(4):362-77
references: 17354371
references: J Health Econ. 2008 Mar;27(2):201-17
references: 18206255
references: Inquiry. 2006-2007 Winter;43(4):345-61
references: 17354370
references: Health Serv Res. 2009 Dec;44(6):2040-59
references: 19780856