State Variability in Children’s Medicaid/CHIP Crowd-Out Estimates

Abstract

Background: Health insurance crowd-out occurs when individuals enrolled in a public health insurance plan would have enrolled in a private plan but for the public option. The crowding-out of private insurance is often used to criticize state Medicaid and Children's Health Insurance Program (CHIP) expansion, as already insured children move their coverage to the states at the public's expense. A difficulty in discussing crowd-out comes from inconsistent estimates. Previous work focusing on the expansion of public programs has led to estimates ranging from 0% to 50% of the children newly insured on public plans being crowded-out. Methods:We apply a regression discontinuity approach to estimate how many children near the state Medicaid/CHIP threshold are crowded-out of private insurance. This approach allows estimates of crowd-out near the eligibility threshold independent of any expansion. Data from the American Community Survey's yearly survey of American households allows for state-level estimates of crowd-out. Results:We find considerable heterogeneity in the crowd-out that occurs in each state, ranging from no crowd-out to over 18% in states with similar eligibility thresholds. Additionally, we found that as state eligibility thresholds increase, children are less likely to be crowded-out.Discussion: This research indicates that national estimates of crowd-out are inappropriate, as statespecific Medicaid and CHIP programs have state-specific crowd-out. Additionally, it indicates that wealthier families that are eligible for public insurance are less likely to switch from private to public coverage than families earning less. Future work should identify reasons for the heterogeneity among states.

Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009–2010

“…The extent and nature of crowd out remain under debate, with previous estimates ranging widely. 22,23 The cross-sectional nature of NS-CSHCN data do not permit an exploration of why particular CSHCN and their families experienced a change in coverage type. Research is needed on the individuallevel factors that contribute to changes in insurance and to determine whether crowd out, specifically, has been a factor among CSHCN.…”

The Effect of Medicaid Eligibility on Utilization of Services and Access to Care among Health Center Patients: A Regression Discontinuity Design

“…Notably, slightly more than half of all states implemented Medicaid expansion in 2014 (see Table 1). Following the previous research [35,36], we restricted the sample to health center patients aged 18 to 65 whose normalized household incomes were $25,000 dollars above or below the Medicaid eligibility thresholds. In addition, the income between 100% and 200% FPL was typically regarded as a low-income population which is our target sample.…”

Children’s Insurance Coverage and Crowd-Out Through the Recession: Lessons From Ohio

“…When we compared with another study, which used the American Community Survey, the 2012 estimate of 5.55% is very close to that study's 2012 estimate of 5.23%. 19 Although the trend from 2004 to 2012 suggests that local crowdout may have declined modestly from 8.07% to 5.55%, the confidence intervals show no statistically significant change over time.…”