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The effects of state policy design features on take-up and crowd-out rates for the state children's health insurance program

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  • Cynthia Bansak

    (San Diego State University)

  • Steven Raphael

    (University of California Berkeley)

Abstract

We evaluate the effects of state policy design features on SCHIP take-up rates and on the degree to which SCHIP benefits crowd out private benefits. The results indicate overall program take-up rates of approximately 10 percent. However, there is considerable heterogeneity across states, suggesting a potential role of inter-state variation in policy design. We find that several design mechanisms have significant and substantial positive effects on take-up. For example, eliminating asset tests, offering continuous coverage, simplifying the application and renewal processes, and extending benefits to parents all have sizable and positive effects on take-up rates. Mandatory waiting periods, on the other hand, consistently reduce take-up rates. In all, inter-state differences in outreach and anti-crowd-out efforts explain roughly one-quarter of the crossstate variation in take-up rates. Concerning the crowding out of private health insurance benefits, we find that between one-quarter and one-third of the increase in public health insurance coverage for SCHIP-eligible children is offset by a decline in private health coverage. We find little evidence that the policy-induced variation in take-up is associated with a significant degree of crowd out, and no evidence that the negative effect on private coverage caused by state policy choices is any greater than the overall crowding-out effect. This suggests that states are not augmenting take-up rates by enrolling children that are relatively more likely to have private health insurance benefits. © 2006 by the Association for Public Policy Analysis and Management.

Suggested Citation

  • Cynthia Bansak & Steven Raphael, 2007. "The effects of state policy design features on take-up and crowd-out rates for the state children's health insurance program," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 26(1), pages 149-175.
    • Handle: RePEc:wly:jpamgt:v:26:y:2007:i:1:p:149-175
    DOI: 10.1002/pam.20231
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    References listed on IDEAS

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    Cited by:

    1. James Marton & Angela Snyder & Mei Zhou, 2016. "Enhanced Citizenship Verification And Children'S Medicaid Coverage," Economic Inquiry, Western Economic Association International, vol. 54(3), pages 1670-1683, July.
    2. Andrea Brandolini & Silvia Magri & Timothy M. Smeeding, 2010. "Asset-based measurement of poverty," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 29(2), pages 267-284.
    3. Sean Orzol & Linda Barterian & Michael Barna, "undated". "Proven Strategies in Health Care Coverage Program Outreach and Enrollment," Mathematica Policy Research Reports 2f2980ef67654808b495e7782, Mathematica Policy Research.
    4. Mark C. Long & Victor Saenz & Marta Tienda, 2010. "Policy Transparency and College Enrollment: Did the Texas Top Ten Percent Law Broaden Access to the Public Flagships?," The ANNALS of the American Academy of Political and Social Science, , vol. 627(1), pages 82-105, January.
    5. repec:mpr:mprres:7819 is not listed on IDEAS
    6. Buchmueller Thomas C & Lo Sasso Anthony T & Wong Kathleen N, 2008. "How Did SCHIP Affect the Insurance Coverage of Immigrant Children?," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 8(2), pages 1-25, January.
    7. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    8. Saavedra, Martin, 2017. "Children's health insurance, family income, and welfare enrollment," Children and Youth Services Review, Elsevier, vol. 73(C), pages 182-186.
    9. Xiaoxue Li, 2020. "Quality information disclosure and health insurance demand: evidence from VA hospital report cards," International Journal of Health Economics and Management, Springer, vol. 20(2), pages 177-199, June.
    10. Cynthia Bansak & Steven Raphael, 2008. "The State Children's Health Insurance Program and Job Mobility: Identifying Job Lock among Working Parents in Near-Poor Households," ILR Review, Cornell University, ILR School, vol. 61(4), pages 564-579, July.
    11. Bronchetti, Erin Todd, 2014. "Public insurance expansions and the health of immigrant and native children," Journal of Public Economics, Elsevier, vol. 120(C), pages 205-219.
    12. Stephanie Riegg Cellini, 2009. "Crowded Colleges and College Crowd-Out: The Impact of Public Subsidies on the Two-Year College Market," American Economic Journal: Economic Policy, American Economic Association, vol. 1(2), pages 1-30, August.

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