Ann Arbor Research Conferences

California's outreach efforts to enroll children in Medicaid and SCHIP included paying enrollment assistants $50 for each accepted application. Entities that received payments included community organizations, insurance brokers, and tax preparers. Jacobson and Buchmueller examine characteristics of organizations that facilitated applications and find insurance brokers were particularly successful at reaching those on the higher end of the income spectrum of those eligible to participate.

While earlier work finds children of immigrants are less likely to enroll in Medicaid when eligible than children of the native born, Buchmueller, Lo Sasso and Wong find similar take up rates for both groups in the State Children's Health Insurance Program (SCHIP.) They also find lower rates of crowding out of private coverage by public coverage among immigrants.

Data from the Fragile Families and Child Wellbeing survey provide an opportunity to learn more about the relationship between the health and health insurance status of parents and children. While almost all births studied were covered by health insurance, one year later about one third of mothers and 10 percent of children were uninsured. Noonan, Reichman, Corman and Carroll find a child's health status has little effect on whether the mother or child become uninsured. Mother's and father's health status, however, did have an effect. Mothers with physical health conditions were less likely to lose public coverage while mothers with mental illness were more likely to lose public coverage, while father's poor health made it more likely that the mother, but not the child, would lose private coverage.

Most Americans who reach age 65 have health insurance through Medicare. For a minority, Medicare means gaining health insurance coverage. Polsky and coauthors find Medicare increases the probability that the previously uninsured report excellent or very good health, decreases their probability of having good health, and has no effect on having poor or fair health. However, Medicare has a similar effect on those who already had health insurance. This suggests Medicare helps the relatively healthy, but does not help those who are already in declining health when they reach Medicare age.

Few studies have examined trends and changes in coverage duration and transitions over time, especially among children. Ham, Li and Shore-Sheppard’s preliminary analyses find health insurance for children became more volatile over the period from 1986 to 1999., and more children moved across health insurance arrangements, including being uninsured. Expansions of Medicaid and SCHIP increased transitions out of uninsurance, increasing both overall coverage and volatility in coverage.

States differ in the extent to which health insurance premiums can vary with health insurance status. Differences between states with and without regulation provide an opportunity to examine how premiums vary with health insurance status and how this affects whether those with chronic health conditions have health insurance. Herring and Pauly find people who live in states that do not regulate health insurance premiums and who have chronic health conditions pay modestly higher premiums and are somewhat less likely to obtain coverage. In states with regulation, there appears to be no effect of chronic conditions on premium levels or coverage.

The public subsidy for health insurance through the tax system has not been investigated in a general equilibrium framework. Jeske and Kitao find a complete removal of the current tax subsidies for health insurance would reduce the number who have health insurance, as current tax subsidies encourage pooling of risks. Without the subsidy, many low risk, young and healthy people would decide not to buy health insurance.