Previous studies suggest access to and satisfaction with care may be different for enrollees in S-CHIP and Medicaid, but it is unclear whether those differences are fully explained by socioeconomic characteristics of the enrollees. We analyze access and satisfaction of three groups of children: Medicaid enrolled, S-CHIP enrolled, and children who are income eligible for Medicaid but carry a card similar to the state's S-CHIP children's card. Both enrollees and providers may believe that these children are enrolled in S-CHIP despite the fact that reimbursement is through the state's Medicaid system. Results indicate that the same network of providers treat, or are perceived by families to treat, the three groups differently. They support the notion that some of the differences in satisfaction between S-CHIP and Medicaid enrollees are related to unmeasured characteristics (for example, income) of the families in the different programs, but that programmatic identity contributes substantially to differential care experience.

All health care spending from public and private sources, such as governments and businesses, is ultimately paid by individuals and families. We calculated the burden of US health care spending on families as a percentage of income and found that at the national level, lower-income families pay a larger share of their incomes toward health care than do higher-income families. Specifically, we found that payments made privately, such as those for health insurance or out-of-pocket spending for care, and publicly, through taxes and tax expenditures, consumed more than 20 percent of family income for families in the lowest-income quintile but no more than 16 percent for families in any other income quintile. Our analysis provides a framework for considering the equity of various initiatives under health reform. Although many effects remain to be seen, we find that, overall, the Affordable Care Act should reduce inequities in the burden of paying for national health care spending.

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We examine the impact of Children’s Health Insurance Program (CHIP) eligibility expansions 1999 to 2012 on child and joint parent/child insurance coverage. We use changes in state CHIP income eligibility levels and data from the Current Population Survey Annual Social and Economic Supplement to create child/parent dyads. We use logistic regression to estimate marginal effects of eligibility expansions on coverage in families with incomes below 300% federal poverty level (FPL) and, in turn, 150% to 300% FPL. The latter is the income range most expansions targeted. We find CHIP expansions increased public coverage among children in families 150% to 300% FPL by 2.5 percentage points (pp). We find increased joint parent/child coverage of 2.3 pp ( P = .055) but only in states where the public eligibility levels for parent and child are within 50 pp. In these states, the CHIP expansion increased the probability that both parent/child are publicly insured (2.5 pp) among insured dyads, but where the eligibility levels are further apart (51-150 pp; >150 pp), CHIP expansions increase the probability of mixed coverage—one public, one private—by 0.9 to 1.5 pp. Overall, families made decisions regarding coverage that put the child first but parents took advantage of joint parent/child coverage when eligibility levels were close. Joint public parent/child coverage can have positive care-seeking effects as well as reduced financial burdens for low-income families.

Objective. To estimate the effect of premium increases on the probability that nearpoor and moderate-income children disenroll from public coverage. Data Sources. Enrollment, eligibility, and claims data for Georgia's PeachCare for Kids TM (CHIP) program for multiple years. Study Design. We exploited policy-induced variation in premiums generated by cross-sectional differences and changes over time in enrollee age, family size, and income to estimate the duration of enrollment as a function of the effective (per child) premium. We classify children as being of low, medium, or high illness severity. Principal Findings. A dollar increase in the per-child premium is associated with a slight increase in a typical child's monthly probability of exiting coverage from 7.70 to 7.83 percent. Children with low illness severity have a significantly higher monthly baseline probability of exiting than children with medium or high illness severity, but the enrollment response to premium increases is similar across all three groups. Conclusions. Success in achieving coverage gains through public programs is tempered by persistent problems in maintaining enrollment, which is modestly affected by premium increases. Retention is subject to adverse selection problems, but premium increases do not appear to significantly magnify the selection problem in this case. Key Words. CHIP, cost sharing, public policy, child health Since its introduction in 1999, Georgia's Children's Health Insurance Program (CHIP), PeachCare for Kids TM (PCK), has been very successful in expanding health insurance coverage for Georgia's low-income children, those at risk of being otherwise uninsured. At any given time, between 8 and 10 percent of Georgia's children are enrolled in this program. Nationally, empirical evidence suggests that state program characteristics are partially determinative of the relative success of CHIP in reducing the number of uninsured children within each state (Sommers 2005; Wolfe and Scrivner A key program characteristic is the choice of whether and at what level to impose CHIP premiums. Our study provides a unique insight into the effect of the marginal premium on the duration of CHIP enrollment episodes. Most of the prior studies rely exclusively on premium variation generated by the time-dependent implementation of a new premium (extensive margin) or a (generally) smaller premium change equally applicable to all families (intensive margin). In contrast, we exploit policy-induced variation in premiums generated by cross-sectional differences and changes over time in enrollee age, family size, and income to estimate the duration of enrollment as a function of the effective (per child) premium (i.e., a dose response). Thus, the effect we estimate is the "per dollar" effect of a premium increase based on a much broader range of premium changes along the intensive margin than is typical in the literature.An estimate of such price responsiveness is useful information for policy makers thinking about how families might respond to c...