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Consequences of SCHIP Expansions for Household Well-Being

In: Frontiers in Health Policy Research, volume 13

Author

Listed:
  • Lindsey Leininger
  • Helen Levy
  • Diane Schanzenbach

Abstract

About 7.4 million children were covered by the State Children's Health Insurance Program (SCHIP) at some point during fiscal year 2008. Many of these children would probably have had private coverage in the absence of SCHIP; recent estimates of the extent of "crowd-out" associated with SCHIP are about 60 percent (Gruber and Simon 2008). The high rate of crowd-out means that the program is not as effective as it could be at reducing the number of uninsured children and has been a political liability for the program. Both political concerns and policy research focusing on crowd-out in SCHIP build on more than a decade of similar attention to the crowd-out associated with the Medicaid expansions of the late 1980s and early 1990s. While there is little doubt that expanding eligibility for public insurance to children who are not poor will lead some to substitute public for private coverage, this substitution should increase total resources available to these households in two ways. First, those who drop private coverage in order to enroll their children in SCHIP can take whatever they had been spending on health insurance and spend it on something else. Second, public insurance requires less cost-sharing than a typical private insurance policy, providing first-dollar coverage with minimal co-payments. This means that switching from private to public coverage reduces a family's out-of-pocket medical spending, freeing up even more of the family's resources for other uses. From the perspective of a low-income family, then, crowd-out is a windfall. In this paper we ask: what do these families do with the additional resources? We address this question with an empirical analysis of consumption data from the Consumer Expenditure Survey. We find that eligibility for SCHIP is associated with an increase in overall expenditure, and most of this increase is allocated to consumption of transportation or saving for retirement. These results suggest that the SCHIP expansion
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Suggested Citation

  • Lindsey Leininger & Helen Levy & Diane Schanzenbach, 2010. "Consequences of SCHIP Expansions for Household Well-Being," NBER Chapters, in: Frontiers in Health Policy Research, volume 13, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberch:12342
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    References listed on IDEAS

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    1. Lipton, Brandy, 2019. "Adult Medicaid Benefit Generosity and Receipt of Recommended Health Services among Low-Income Children: The Spillover Effects of Medicaid Adult Dental Coverage Expansions," MPRA Paper 93248, University Library of Munich, Germany.
    2. O'Donnell, Owen, 2024. "Health and health system effects on poverty: A narrative review of global evidence," Health Policy, Elsevier, vol. 142(C).
    3. Boudreaux, Michel H. & Golberstein, Ezra & McAlpine, Donna D., 2016. "The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin," Journal of Health Economics, Elsevier, vol. 45(C), pages 161-175.
    4. Alan Monheit & Jessica Vistnes, 2015. "Does Public Health Insurance for Children Improve Single Mothers’ Health Care Use?," Journal of Family and Economic Issues, Springer, vol. 36(4), pages 581-592, December.
    5. Lucie Schmidt & Lara Shore-Sheppard & Tara Watson, 2016. "The Effect of Safety-Net Programs on Food Insecurity," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 589-614.
    6. Dahl, Gordon B. & Forbes, Silke J., 2023. "Doctor switching costs," Journal of Public Economics, Elsevier, vol. 221(C).
    7. Kofinti, Raymond Elikplim & Koomson, Isaac & Paintsil, Jones Arkoh & Ameyaw, Edward Kwabena, 2022. "Reducing children's malnutrition by increasing mothers' health insurance coverage: A focus on stunting and underweight across 32 sub-Saharan African countries," Economic Modelling, Elsevier, vol. 117(C).
    8. Panchalingam, Thadchaigeni, 2020. "Effects of Public Health Insurance Expansions on Consumption Expenditures of Targeted Households," 2020 Annual Meeting, July 26-28, Kansas City, Missouri 304513, Agricultural and Applied Economics Association.
    9. repec:mrr:papers:wp341 is not listed on IDEAS
    10. Michael Manville & Brian D. Taylor & Evelyn Blumenberg & Andrew Schouten, 2023. "Vehicle access and falling transit ridership: evidence from Southern California," Transportation, Springer, vol. 50(1), pages 303-329, February.
    11. Lipton, Brandy J., 2021. "Adult Medicaid benefit generosity and receipt of recommended health services among low-income children: The spillover effects of Medicaid adult dental coverage expansions," Journal of Health Economics, Elsevier, vol. 75(C).
    12. Hull, Marie C. & Yan, Ji, 2024. "The Impact of Children's Access to Public Health Insurance on Their Cognitive Development and Behavior," IZA Discussion Papers 17190, Institute of Labor Economics (IZA).
    13. Noghanibehambari, Hamid, 2022. "Intergenerational health effects of Medicaid," Economics & Human Biology, Elsevier, vol. 45(C).
    14. Bhashkar Mazumder & Sarah Miller, 2014. "The Effects of the Massachusetts Health Reform on Financial Distress," Working Paper Series WP-2014-1, Federal Reserve Bank of Chicago.
    15. Qureshi, Javaeria A. & Gangopadhyaya, Anuj, 2021. "Childhood Medicaid Eligibility and Human Capital," Economics of Education Review, Elsevier, vol. 82(C).
    16. Dhaval M. Dave & Robert Kaestner & George L. Wehby, 2019. "Does public insurance coverage for pregnant women affect prenatal health behaviors?," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(2), pages 419-453, April.
    17. 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.

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