Substitution Of SCHIP For Private Coverage: Results From A 2002 Evaluation In Ten States

Abstract

This paper examines the extent to which the State Children's Health Insurance Program (SCHIP) might be substituting for private health insurance coverage at the time of enrollment. Among children who were newly enrolled in SCHIP in 2002 in ten states, about 14 percent had private coverage that they could have retained as an alternative to SCHIP. Of this 14 percent, about half of parents reported that the private coverage was unaffordable compared with SCHIP. This suggests that relatively few SCHIP enrollees could have retained private coverage and that even fewer had parents who felt that the option was affordable.

Public-Private Substitution Among Medicaid Adults: Evidence from Ohio

“…The second approach relies on primary data collection to estimate the effect of public eligibility on private insurance (usually referred to as public-private substitution rather than crowd-out). The first large scale use of this approach was in a congressionally mandated survey of Medicaid beneficiaries in seventeen states (Sommers et al, 2007). The approach has subsequently been used to estimate the magnitude of substitution in New York (Shone, Lantz, Dick, Chernew, Szilagyi, 2008).…”

“…This study applies a variant of the primary data collection approach used by Sommers et al (2007) and Shone et al (2008). Instead of a sample based on Medicaid administrative records, this study uses two years of an ongoing population-based household survey, the Ohio Family The 2008 OFHS was a computer assisted telephone interview (CATI) that employed a dual-framed, stratified, random digit dial (RDD) telephone survey of 50,944 Ohio residents.…”

“…Despite the fact that each state implements their own substitution prevention techniques, only a few studies have produced substitution estimates for individual states. Importantly, Sommers, Zuckerman, Dubay, and Kenney (2007) found private-public substitution for children covered by CHIP ranging from a low of 7.4% to a high of 19.1% for ten study states in 2002. No study has examined the stability of substitution across time.…”

“…The OFHS sampling frames include both publicly and privately insured households, and the full sample allows comparisons of the substitution findings to low-income, privately insured population in Ohio. Sommers et al (2007) highlights the importance of distinguishing between voluntary and involuntary substitution. Due to Medicaid's role as a safety net program, much substitution of public insurance for private coverage will be involuntary, with loss of employment being the most frequent reason for voluntary substitution.…”

“…This study follows Nogle and Shenkman (2004) and Allison, St. Peter, Huang, and LaClair (2003) by defining voluntary substitution as cases where new adult Medicaid enrollees: (a) had private insurance coverage immediately prior to their Medicaid coverage and (b) are still eligible for an employer sponsored group plan. Previous research also has found that half of parents who could put their child on an employer sponsored plan, but instead chose CHIP, reported that their employer plan was unaffordable (Sommers et al 2007). A second estimate will exclude from the substitution results those individuals reporting that their employer sponsored plan was not affordable.…”