Treatment or Placebo: Are State Programs Decreasing the Proportion of Uninsured?

Abstract

Currently there are over 45 million Americans without health insurance. Recent growth in Medicaid and State Children's Health Insurance Program (SCHIP) enrollment of children has filled in the sizable gap created by decreased employer‐sponsored insurance since 2000. While the share of children who are uninsured actually decreased between 2000 and 2003, little progress was made in expanding public insurance to adults. As a result, advocates and policymakers at the federal and state level are searching for approaches to deal with the growing number of the uninsured. Conservatives advocate encouraging individuals to buy private insurance while liberals advocate the provision of health coverage through publicly financed health care. Using a 50‐state multilevel individual growth model, this study estimates the net effect of two state approaches in terms of reducing the uninsured: tax incentives (the conservative approach) and direct‐coverage programs (the liberal approach). The results suggest that these approaches have not achieved the results that many advocates had suggested. In the case of tax incentives, the results suggest that states with tax incentives experience increases in the rate of the uninsured. In the case of direct‐coverage programs, results suggest that states receive no relief in the number of uninsured individuals. Finally, the analysis suggests that the efforts originating at the federal level are most successful. These programs are a continuation of the incremental approach policymakers in America have taken to address the problem of the uninsured, rather than taking steps toward a truly comprehensive solution.

Risky Business: Effectiveness of State Market-Based Health Programs

“…This study seeks to examine the effects of greater state effort with regard to market-based health policy efforts on selected indicators and does not seek to disentangle these effects from those of state-based programs. Prior research (Bernick and Myers 2008) found that the effects of tax incentives and even state-based direct coverage programs were obscured by the effects of Medicaid, still the major force for health insurance provision in the states. Thus, this study sought to test for the effects of market-based programs in the absence of these other programs.…”

The Politics of Need: Examining Governors' Decisions to Oppose the “Obamacare” Medicaid Expansion

“…The size of the uninsured population among the states may affect states’ choices to expand Medicaid. Medicaid expansions were the sole effective tool used by states to increase health insurance coverage in the aftermath of the Clinton health reforms (Barrilleaux and Brace 2007; Bernick and Myers 2008; Kail, Quadagno, and Dixon 2009), but only a handful of states with the most generous prior Medicaid policies used that approach to reducing uninsurance. Thus, Medicaid expansion is a policy tool that has proved to work well in reducing the numbers of uninsured in the states.…”

Party Control, Policy Reforms, and the Impact on Health Insurance Coverage in the U.S. States*

“…Two recent studies provide mixed support for the effectiveness of state reforms. Bernick and Myers (2008) suggest that neither tax incentives nor direct coverage programs are particularly effective at addressing the insurance problem and that states that adopt tax incentives may even increase the number of uninsured. Kail, Quadagno, and Dixon (2009) demonstrate that waivers for Medicaid and SCHIP programs, which allow states to expand coverage to targeted populations, are the only reforms that significantly increase coverage.…”

“…Another reason for the difference in party effects may be the preferred policy approaches. Republicans typically like to rely on the private sector, which makes tax incentives for insurance coverage a more appealing option, but, as Bernick and Myers (2008) show, these incentives seem to be ineffective and may even increase the uninsured population. Lastly, Grogan (1994) finds that Republican control reduces eligibility for health insurance, which is inversely related to the possible expansion of coverage.…”

“…Additionally, poorer states may not have the resources to expand coverage as much as other states. Research shows that states with a larger minority population have higher uninsured rates (Bernick and Myers, 2008). This is probably because minority groups are less likely to have jobs that provide coverage.…”