The stigma of public programs: Does a separate S‐CHIP program reduce it?

Ketsche, Patricia; Adams, E. Kathleen; Minyard, Karen; Kellenberg, Rebecca

doi:10.1002/pam.20285

Cited by 22 publications

(19 citation statements)

References 15 publications

(14 reference statements)

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“…As is shown in Ketsche et al (2007a) there is some stigma associated with Medicaid enrollment in Georgia relative to enrollment in the PeachCare program, which is perceived to be more like a private health plan. PeachCare premium increases may reinforce this perception and thus increase the stigma associated with Medicaid enrollment.…”

Section: Premium Changesmentioning

confidence: 87%

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysis

2009

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Faced with state budget troubles, policymakers may introduce or increase State Children's Health Insurance Program (SCHIP) premiums for children in the highest program income eligibility categories. In this paper we compare the responses of SCHIP recipients in a state (Kentucky) that introduced SCHIP premiums for the first time at the end of 2003 with the responses of recipients in a state (Georgia) that increased existing SCHIP premiums in mid-2004. We start with a theoretical examination of how these different policies create different changes to family budget constraints and produce somewhat different financial incentives for recipients. Next we empirically model the impact of these policies using a competing risk approach to differentiate exits due to transfers to other eligibility categories of public coverage from exiting the public health insurance system. In both states we find a short-run increase in the likelihood that children transfer to lower- income eligibility/lower-premium categories of SCHIP. We also find a short-run increase in the rate at which children transfer from SCHIP to Medicaid in Kentucky, which is consistent with our theoretical model. These findings have important financial implications for state budgets, as the matching rates and premium levels are different for different eligibility categories of public coverage.

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Section: Premium Changesmentioning

confidence: 87%

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysis

2009

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“…The magnitude of the effects may be small for several reasons; the availability of charity care has been shown to reduce the demand for health insurance and increase the likelihood of being uninsured, especially among the low-income population (Herring 2005;Rask and Rask 2000). Additionally, information and administrative costs, along with the perceived stigma and reputation of public insurance, have been shown to be important barriers to enrollment in public insurance programs (Aizer 2007;Ketsche et al 2007). …”

Section: Discussion and Policy Implicationsmentioning

confidence: 99%

Public and Private Health Insurance Premiums: How Do They Affect the Health Insurance Status of Low-Income Adults? Childless

Guy

Adams²,

Atherly³

2012

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The Patient Protection and Affordable Care Act (ACA) will substantially increase public health insurance eligibility and alter the costs of insurance coverage. Using Current Population Survey (CPS) data from the period 2000–2008, we examine the effects of public and private health insurance premiums on the insurance status of low-income childless adults, a population substantially affected by the ACA. Results show higher public premiums to be associated with a decrease in the probability of having public insurance and an increase in the probability of being uninsured, while increased private premiums decrease the probability of having private insurance. Eligibility for premium assistance programs and increased subsidy levels are associated with lower rates of uninsurance. The magnitudes of the effects are quite modest and provide important implications for insurance expansions for childless adults under the ACA.

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“…The magnitude of the effects found in this study may be small for several reasons; the availability of charity care has been shown to reduce the demand for health insurance and increase the likelihood of being uninsured, especially among the low-income population (Rask and Rask 2000;Herring 2005). Additionally, information and administrative costs, along with the perceived stigma and reputation of public insurance have been shown to be important barriers to enrollment in public insurance programs (Aizer 2007;Ketsche et al 2007).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Cost Sharing on Access to Care among Childless Adults

Guy

2010

Health Services Research

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Objectives. To analyze the impact of public health insurance expansions and the use of enrollee cost sharing on insurance status and receipt of clinically indicated preventive screenings and physician services. Data Source. This study uses Behavioral Risk Factor Surveillance System (BRFSS) data from 1997 to 2007. Study Design. This study uses multivariate difference-in-difference logistic regression modeling of pooled cross-sectional time series data. The effect of the expansions on insurance status and access to care is identified by cross-state variation in program implementation, as well as cross-state and within-state variation in program eligibility criteria over time. Principal Findings. Childless adult expansions, regardless of cost-sharing levels, reduced uninsurance rates and decreased the likelihood that childless adults needed to see a physician but did not because of cost. Expansions with traditional public insurance cost-sharing requirements increased the use of preventive screenings, while expansions with increased cost-sharing requirements did not. Conclusions. Cost-sharing requirements did not have an impact on the ability to see a physician when needed, but they played an important role in the utilization of preventive services. Expanding public health insurance to low-income, childless adults presents a promising policy opportunity, but there are trade-offs between the efficiencies obtained through increased cost sharing and the potential inefficiencies due to the lower use of preventive services.

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The stigma of public programs: Does a separate S‐CHIP program reduce it?

Cited by 22 publications

References 15 publications

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysis

SCHIP premiums, enrollment, and expenditures: a two state, competing risk analysis

Public and Private Health Insurance Premiums: How Do They Affect the Health Insurance Status of Low-Income Adults? Childless

The Effects of Cost Sharing on Access to Care among Childless Adults

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