Incremental Strategies for Providing Health Insurance for the Uninsured: Projected Federal Costs and Number of Newly Insured
23 July
K.E. Thorpe, "Incremental Strategies for Providing Health Insurance for the Uninsured: Projected Federal Costs and Number of Newly Insured," Journal of the American Medical Association (23 July 1997).
By September 1996, thirty-four states exceeded federal mandates for eligibility for children and pregnant women, eleven exceeded income thresholds for children between ages one and five, and twenty-four states exceeded federal minimums for children ages six and older. National Governors' Association, State Strategies for Increasing Health Coverage for Uninsured Children, Issue Brief (Washington: NGA, 4 March 1997).
For detailed descriptions, see National Governors' Association, Innovative State Health Insurance Initiatives for Children (Washington: NGA, 21 July 1995).
See, Committee on Ways and Means, Overview of Entitlement Programs, 1993 Green Book (Washington: U.S. Government Printing Office, July 1993). These data report that 0.5 percent of eligible families took advantage of the advance-payment option. More recent, unpublished data from the Treasury Department place this figure at 1 percent. Several theories exist concerning the low participation rate, including lack of knowledge of the option, families' reluctance to go through their employer to initiate the advance payment, and concern that changes during the year (for example, in family structure or income) could result in a tax bill when taxes are actually filed.
According to unpublished data from the Treasury Department, during the final year of the program, more than $760 million - some $260 per family - was spent under the supplemental child health insurance credit program.
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Does Public Insurance Crowd Out Private Insurance?
May
Compare, for example, D. Cutler and J. Gruber, "Does Public Insurance Crowd Out Private Insurance?" Quarterly Journal of Economics (May 1996): 391-430; and K.E. Thorpe and C. Florence, "Health Insurance Coverage among Children: The Role of Expanded Medicaid Coverage" (New Orleans, La.: Tulane University School of Public Health, January 1997).
New Orleans, La.: Tulane University School of Public Health, January
Compare, for example, D. Cutler and J. Gruber, "Does Public Insurance Crowd Out Private Insurance?" Quarterly Journal of Economics (May 1996): 391-430; and K.E. Thorpe and C. Florence, "Health Insurance Coverage among Children: The Role of Expanded Medicaid Coverage" (New Orleans, La.: Tulane University School of Public Health, January 1997).
The financial implications of these choices are important. Use of monthly cash income versus annual income would increase program costs by 20 percent.
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note
For illustration, I use the participation assumptions used by the Department of Health and Human Services to estimate federal costs and participation during President Clinton's first term. Participation in the program varies with the ratio of premium payments to family income, as presented below. Cost of health Insurance as percentage of Income Percent purchasing Insurance Free 75% Less than 2% 60 2-6% 40 6-10% 30 10-14% 25 14-20% 18 20% or more 12
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note
Although eligibility for the program stipulates that children must be uninsured for six months prior to entering the program, I assumed that families with a financial incentive to enroll their children in the new program would do so. As a result, these estimates may overstate the federal costs of the program.
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