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Ports KA, Rostad WL, Coyne P, Dunning J, Gonzalez AE, Troy A. A Scoping Review to Identify Community- and Societal-Level Strategies Evaluated from 2013 to 2023 for Their Potential Impact on Child Well-Being in the United States. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1070. [PMID: 39334603 PMCID: PMC11430804 DOI: 10.3390/children11091070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024]
Abstract
There is increased recognition for solutions that address the social determinants of health (SDOHs)-the context in which families are raising children. Unfortunately, implementing solutions that address inequities in the SDOHs has proven to be difficult. Many child and family serving systems and communities do not know where to start or do not have the capacity to identify and implement upstream SDOH strategies. As such, we conducted a scoping review to assess the status of evidence connecting strategies that address the SDOHs and child well-being. A total of 29,079 records were identified using natural language processing with 341 records meeting inclusion criteria (e.g., outcomes focused on child well-being, interventions happening at a population level, and evaluations of prevention strategies in the United States). Records were coded, and the findings are presented by the SDOH domain, such as strategies that addressed economic stability (n = 94), education access and quality (n = 17), food security (n = 106), healthcare access and quality (n = 96), neighborhood and built environment (n = 7), and social and community context (n = 12). This review provides an overview of the associations between population-level SDOH strategies and the impact-good and bad-on child well-being and may be a useful resource for communities and practitioners when considering equitable solutions that promote thriving childhoods.
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Affiliation(s)
- Katie A. Ports
- American Institutes for Research, 1400 Crystal Drive, 10th Floor, Arlington, VA 22202-3289, USA; (W.L.R.); (P.C.); (J.D.); (A.E.G.); (A.T.)
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Chu J, Roby DH, Boudreaux MH. Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access. Health Serv Res 2022; 57 Suppl 2:315-325. [PMID: 36053731 PMCID: PMC9660422 DOI: 10.1111/1475-6773.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate the effects of Children's Health Insurance Reauthorization Act (CHIPRA), a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization, and health outcomes among immigrant children. DATA SOURCES Restricted use 2000-2016 National Health Interview Survey (NHIS). STUDY DESIGN We used a difference-in-differences design that compared changes in CHIPRA expansion states to changes in non-expansion states. DATA COLLECTION Our sample included immigrant children who were born outside the US, aged 0-18 with family income below 300% of the Federal Poverty Level (FPL). Subgroup analyses were conducted across states that did and did not have a similar state-funded option prior to CHIPRA (state-funded vs. not state-funded), by the length of time in the US (5 years vs. 5-14 years), and global region of birth (Latin American vs. Asian countries). PRINCIPLE FINDINGS We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: -11.25, -1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state-funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. CONCLUSIONS CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low-income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state-funded coverage. However, we found evidence of crowd-out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well-being of immigrant children but other investments are still needed.
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Affiliation(s)
- Jun Chu
- Department of Sociology, Anthropology and Public HealthThe University of MarylandBaltimore County
| | - Dylan H. Roby
- Department of Health, Society, and Behavior, Public HealthUniversity of CaliforniaIrvineCaliforniaUSA
| | - Michel H. Boudreaux
- Department of Health Policy and Management, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
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Alker JC, Kenney GM, Rosenbaum S. Children's Health Insurance Coverage: Progress, Problems, And Priorities For 2021 And Beyond. Health Aff (Millwood) 2020; 39:1743-1751. [PMID: 33017236 DOI: 10.1377/hlthaff.2020.00785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Expansion of Medicaid and establishment of the Children's Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. That success is reflected in the high rates of coverage and health care access achieved for children, including those in low-income families. But significant coverage gaps remain-gaps that have been increasing since 2016 and are likely to accelerate with the coronavirus disease 2019 (COVID-19) pandemic and the associated recession. Using National Health Interview Survey data, we found that the proportion of uninsured children was 5.5 percent in 2018. Children continue to face coverage interruptions, and Latino, adolescent, and noncitizen children continue to face elevated risks of being uninsured. Although we note the benefits of a universal, federally financed, single-payer approach to coverage, we also offer two possible reform pathways that can take place within the current multipayer system, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.
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Affiliation(s)
- Joan C Alker
- Joan C. Alker is a research professor at the McCourt School of Public Policy, Georgetown University, in Washington, D.C
| | - Genevieve M Kenney
- Genevieve M. Kenney is a codirector and senior fellow in the Health Policy Center, Urban Institute, in Washington, D.C
| | - Sara Rosenbaum
- Sara Rosenbaum is the Hirsh Professor and founding chair of the Department of Health Policy, Milken Institute School of Public Health, George Washington University, in Washington, D.C
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Yasenov VI, Lawrence D, Mendoza FS, Hainmueller J. Public Health Insurance Expansion for Immigrant Children and Interstate Migration of Low-Income Immigrants. JAMA Pediatr 2020; 174:22-28. [PMID: 31738388 PMCID: PMC6865314 DOI: 10.1001/jamapediatrics.2019.4241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/28/2019] [Indexed: 01/07/2023]
Abstract
Importance Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to non-US-born children and pregnant women who are lawful permanent residents during their first 5 years of residency in the United States. In other states, there were concerns that insurance expansion could attract immigrants to relocate to gain free health insurance coverage. Objective To examine whether expansion of public health insurance to non-US-born, lawful permanent resident children and pregnant women during their first 5 years of residency is associated with increased interstate migration among these groups. Design, Setting, and Participants This difference-in-differences analysis included data on 208 060 immigrants from the American Community Survey from 2000 through 2016, with analysis including all 50 states and the District of Columbia. The study sample included 2 treatment groups that became eligible under the expanded coverage: lawful permanent resident adults with at least 1 non-US-born child younger than 18 years (n = 36 438) and lawful permanent resident women of reproductive age (n = 87 418). Control groups that remained ineligible under the expanded coverage included lawful permanent resident adults without non-US-born children (n = 171 622), lawful permanent resident single men (n = 56 142), and lawful permanent resident postreproductive women (n = 15 129). A difference-in-differences design compared migration rates between eligible and ineligible immigrant groups before and after insurance coverage expansions. Data analysis was performed from November 3, 2018, to May 31, 2019. Exposures Public health insurance coverage for immigrant women and children who were lawful permanent residents within 5 years of residency. Main Outcomes and Measures Migration to a health expansion state from any other state and from a neighboring state. Results Of 208 060 immigrants (47% women in the weighted sample; mean [SD] age, 32.97 [12.94] years; 63% Hispanic), the mean (SD) annual move rate across the entire sample was 3% (17%). Expansion of public health insurance to non-US-born children or pregnant women within their first 5 years of residency was not associated with interstate movement for health care benefits. Coverage expansion for non-US-born children of lawful permanent residents was not associated with a change in the rate of in-migration higher than 1.78 percentage points or lower than -1.28 percentage points. The corresponding estimate for coverage expansion of lawful permanent resident pregnant women was a change higher than 1.38 percentage points and lower than -1.20 percentage points. Conclusions and Relevance The results suggest that states considering expanding health care benefits coverage to recently arrived immigrant children and pregnant women may be unlikely to experience in-migration of these persons from other states, which has important implications for understanding short- and long-term program costs.
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Affiliation(s)
- Vasil I. Yasenov
- Immigration Policy Lab, Stanford University, Stanford, California
- Institute of Labor Economics (IZA), Bonn, Germany
| | - Duncan Lawrence
- Immigration Policy Lab, Stanford University, Stanford, California
| | - Fernando S. Mendoza
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jens Hainmueller
- Immigration Policy Lab, Stanford University, Stanford, California
- Department of Political Science, Stanford University, Stanford, California
- Graduate School of Business, Stanford University, Stanford, California
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Knipper SH, Rivers W, Goodman JM. Effects of citizenship status, Latino ethnicity, and household language on health insurance coverage for U.S. adolescents, 2007-2016. Health Serv Res 2019; 54:1166-1173. [PMID: 31385302 DOI: 10.1111/1475-6773.13198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE/STUDY QUESTION To examine changes in uninsurance rates among U.S. adolescents ages 12-17 and assess whether trends over time differed by citizenship status, Latino ethnicity, and household language. DATA SOURCES/STUDY SETTING 2007-2016 National Health Insurance Survey (NHIS). STUDY DESIGN Multivariable logistic regression and postestimation marginal effects were used to assess changes in the current uninsured rate. Logistic regression models were used to determine significant trends over time for each demographic group and compare them to trends in the broader adolescent population. Marginal effects were employed to calculate adjusted outcome probabilities for each year. PRINCIPAL FINDINGS Across all 12- to 17-year-olds, the unadjusted uninsured rate dropped significantly between 2007 and 2016, from 10.2 percent to 6.0 percent. For noncitizen youth, the probability of being uninsured increased from 26.6 percent in 2007 to 28.4 percent in 2016, after controlling for covariates. Latino youth and those in Spanish-speaking households saw declines in their adjusted uninsurance rate that was proportional to non-Latino and English-speaking youth. CONCLUSIONS Most adolescents saw significant improvements in health insurance coverage between 2007 and 2016; however, disparities remain among Spanish-speaking and Latino adolescents and no improvements were seen among noncitizen youth. This suggests a need for equity-focused eligibility, outreach, and enrollment policies that expand insurance options for these populations.
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Seiber EE, Goldstein EV. Disappearing Medicaid Enrollment Disparities for US Citizen Children in Immigrant Families: State-Level Trends from 2008 to 2015. Acad Pediatr 2019; 19:333-341. [PMID: 30665011 DOI: 10.1016/j.acap.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/18/2018] [Accepted: 01/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Medicaid and the Children's Health Insurance Program (CHIP) provide health insurance to 38% of all children in the United States. Uninsured rates continued to fall over the past decade, and citizen children in immigrant families experienced the most dramatic gains. Our objective is to test whether states have managed to close Medicaid enrollment gaps between US citizen children in native and immigrant families. METHODS We use the 2008 to 2015 American Community Surveys to compare uninsured rates for 2.4million Medicaid-eligible citizen children in immigrant and native families. State fixed-effects probit models estimate the probability of children remaining uninsured when eligible for public coverage, excluding children covered by private insurance. We compare the states with the largest enrollment gains across differences in policies relevant to CHIP/Medicaid participation for all children, including CHIP Reauthorization Act (CHIPRA) enrollment simplification, Immigrant Children's Health Improvement Act, and Affordable Care Act (ACA) Medicaid expansion. RESULTS Most states reduced their enrollment disparities by one half or even completely eliminated their enrollment differentials. However, the states with the largest gains did not adopt ACA and CHIPRA policy options that would have improved CHIP/Medicaid participation for children in their states-or implemented the policies long before the observed gains. CONCLUSIONS Rather than policy anchoring the gains, the improvements may be rooted in operational changes and outreach efforts during CHIPRA and ACA implementation. Absent a policy anchor, the large enrollment differentials of a decade ago may reappear for children in immigrant families, affect the wellbeing of children and their communities.
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Affiliation(s)
- Eric E Seiber
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio.
| | - Evan V Goldstein
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
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Soylu TG, Elashkar E, Aloudah F, Ahmed M, Kitsantas P. Racial/ethnic differences in health insurance adequacy and consistency among children: Evidence from the 2011/12 National Survey of Children's Health. J Public Health Res 2018; 7:1280. [PMID: 29780766 PMCID: PMC5941257 DOI: 10.4081/jphr.2018.1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/14/2018] [Indexed: 11/23/2022] Open
Abstract
Background Surveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children's (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months). Design and methods We used data from the 2011/2012 National Survey of Children's Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups. Results Stratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage. Conclusions This study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations.
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Affiliation(s)
- Tulay G Soylu
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Eman Elashkar
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Fatemah Aloudah
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Munir Ahmed
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
| | - Panagiota Kitsantas
- Department of Health Administration and Policy, George Mason University, Fairfax VA, USA
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Chen A, Lo Sasso AT, Richards MR. Supply-side effects from public insurance expansions: Evidence from physician labor markets. HEALTH ECONOMICS 2018; 27:690-708. [PMID: 29194846 DOI: 10.1002/hec.3625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 08/29/2017] [Accepted: 10/24/2017] [Indexed: 06/07/2023]
Abstract
Medicaid and the Child Health Insurance Programs (CHIP) are key sources of coverage for U.S. children. Established in 1997, CHIP allocated $40 billion of federal funds across the first 10 years but continued support required reauthorization. After 2 failed attempts in Congress, CHIP was finally reauthorized and significantly expanded in 2009. Although much is known about the demand-side policy effects, much less is understood about the policy's impact on providers. In this paper, we leverage a unique physician dataset to examine if and how pediatricians responded to the expansion of the public insurance program. We find that newly trained pediatricians are 8 percentage points more likely to subspecialize and as much as 17 percentage points more likely to enter private practice after the law passed. There is also suggestive evidence of greater private practice growth in more rural locations. The sharp supply-side changes that we observe indicate that expanding public insurance can have important spillover effects on provider training and practice choices.
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Affiliation(s)
- Alice Chen
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Anthony T Lo Sasso
- School of Public Health, Health Policy and Administration, Institute of Government and Public Affairs, University of Illinois-Chicago, Chicago, IL, USA
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Affiliation(s)
- Rachel Fabi
- From the Department of Health Policy and Management and the Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Brendan Saloner
- From the Department of Health Policy and Management and the Berman Institute of Bioethics, Johns Hopkins Bloomberg School of Public Health, Baltimore
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Abstract
BACKGROUND Latino populations have disproportionately moved to areas in the Southeast and Midwest (emerging destinations), outside traditional Latino enclaves, in recent years. OBJECTIVE To examine whether health care experiences differ between traditional and emerging destinations for Latino children. RESEARCH DESIGN We defined traditional and emerging destination counties based on levels and changes in the Latino population between 2000 and 2010. Measures were linked to the restricted National Survey of Children's Health along with county-level data from the Area Resource File and Census of State and Local Governments. To compare outcomes among Latino children across destinations, linear probability models adjusted for individual-level characteristics, area-level characteristics, and state fixed effects. MEASURES Outcomes were access to a usual source of care, unmet health care needs, preventive health visit in prior year, and family-centered care. RESULTS Compared with traditional destination counterparts, Latino children in emerging destinations tended to be younger, healthier, and more likely to be in families speaking English at home. Latino children in emerging destinations were significantly less likely to have a usual source of care adjusting for individual-level and county-level variables, but other dimensions of access were similar between destinations. CONCLUSIONS Differences in usual source of care may reflect lower supply of culturally competent providers or limited information about where and how to seek care. For realized access to care, protective factors in emerging destinations, such as higher average incomes in the area and lower community uninsurance rates, might counteract any negative effects of emerging destinations.
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Jarlenski M, Baller J, Borrero S, Bennett WL. Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status. Acad Pediatr 2016; 16:208-15. [PMID: 26329016 DOI: 10.1016/j.acap.2015.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/23/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status. METHODS We used data from the National Survey of Children's Health in 2003 to 2011-2012, including 83,612 children aged 0 to 17 years with family incomes <200% of the federal poverty level. We examined 3 immigration status categories: citizen children with nonimmigrant parents; citizen children with immigrant parents; and immigrant children. We used multivariable regression analyses to obtain adjusted trends in health insurance coverage and access to care. RESULTS All low-income children experienced gains in health insurance coverage and access to care from 2003 to 2011-2012, regardless of family immigration status. Relative to citizen children with nonimmigrant parents, citizen children with immigrant parents had a 5 percentage point greater increase in health insurance coverage (P = .06), a 9 percentage point greater increase in having a personal doctor or nurse (P < .01), and an 11 percentage point greater increase in having no unmet medical need (P < .01). Immigrant children had significantly lower health insurance coverage than other groups. However, the group had a 14 percentage point greater increase in having a personal doctor or nurse (P < .01) and a 26 percentage point greater increase in having no unmet medical need (P < .01) relative to citizen children with nonimmigrant parents. CONCLUSIONS Some disparities in access to care related to family immigration status have lessened over time among children in low-income families, although large disparities still exist. Policy efforts are needed to ensure that children of immigrant parents and immigrant children are able to access health insurance and health care.
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Affiliation(s)
- Marian Jarlenski
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pa; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pa.
| | | | - Sonya Borrero
- Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, Pa; Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pa
| | - Wendy L Bennett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
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Goldstein IM, Kostova D, Foltz JL, Kenney GM. The impact of recent CHIP eligibility expansions on children's insurance coverage, 2008-12. Health Aff (Millwood) 2014; 33:1861-7. [PMID: 25253261 DOI: 10.1377/hlthaff.2014.0208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Following the reauthorization of the Children's Health Insurance Program (CHIP) in 2009, fifteen states raised their CHIP income eligibility thresholds to further reduce uninsurance among children. We examined the impact of these expansions on uninsurance, public insurance, and private insurance among children who became newly eligible for CHIP after the expansions. Using a difference-in-differences approach, we estimated that the expansions reduced uninsurance by 1.1 percentage points among the newly eligible, cutting their uninsurance rate by nearly 15 percent. Public coverage increased by 2.9 percentage points, with variations in take-up among the states. A better understanding of these state-level differences in take-up could inform efforts to enroll children who remain uninsured but are eligible for CHIP. CHIP is up for reauthorization in 2015, and further funding will be needed to maintain the program, which provides insurance to children who might not have access to affordable private coverage.
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Affiliation(s)
- Ian M Goldstein
- Ian M. Goldstein is a resident physician at the University of Colorado, in Denver
| | - Deliana Kostova
- Deliana Kostova is an economist at the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia
| | | | - Genevieve M Kenney
- Genevieve M. Kenney is codirector of and a senior fellow at the Health Policy Center, Urban Institute, in Washington, D.C
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