This article reviews findings from 38 rigorous studies published in the peer-reviewed literature of the impact of the Medicaid/Children's Health Insurance Program (CHIP) expansions on children. There is strong evidence for increases in enrollment in public programs and reductions in uninsurance following eligibility expansions. Medicaid enrollment continued to increase during the CHIP era (a "spillover effect"). Evidence for improved access to and use of services, particularly for dental care, is also very strong. There are fewer studies of health status impacts, and the evidence is mixed. There is a very wide range in the size of effects estimated in the studies reviewed because of the methods used and the populations studied. The review identifies several important research gaps on this topic, particularly the small number of studies of the effects on health status. Both research methods and findings from the child expansions can provide insights for evaluating the coming expansions for adults under the Affordable Care Act.
[Show abstract][Hide abstract] ABSTRACT: This paper uses a policy discontinuity to identify the immediate and long-term effects of public health insurance coverage during childhood. Our identification strategy exploits a unique feature of several early Medicaid expansions that extended eligibility only to children born after September 30, 1983. This feature resulted in a large discontinuity in the lifetime years of Medicaid eligibility of children at this birthdate cutoff. Those with family incomes at or just below the poverty line had close to five more years of eligibility if they were born just after the cutoff than if they were born just before. We use this discontinuity in eligibility to measure the impact of public health insurance on mortality by following cohorts of children born on either side of this cutoff from childhood through early adulthood. We examine changes in rates of mortality by the underlying causes of death, distinguishing between deaths due to internal and external causes. We also examine outcomes separately for black and white children. Our analysis shows that black children were more likely to be affected by the Medicaid expansions and gained twice the amount of eligibility as white children. We find a substantial effect of public eligibility during childhood on the later life mortality of black children at ages 15-18. The estimates indicate a 13-18 percent decrease in the internal mortality rate of black teens born after September 30, 1983. We find no evidence of an improvement in the mortality of white children under the expansions.
[Show abstract][Hide abstract] ABSTRACT: Following changes to federal cash assistance programs in 1996, low-income families now rely on a set of social programs: the Earned Income Tax Credit, food assistance, publicly funded health insurance, and child-care subsidies. In this review, we present evidence on the effects of these programs on families' economic circumstances, families' psychological well-being and functioning, and children's developmental outcomes. Social safety net programs improve families' economic circumstances, thereby achieving their primary goal. Few studies have examined impacts on children's developmental outcomes but overall, programs improve children's academic, behavioral, and physical well-being. Even fewer studies have examined impacts on parents' psychological well-being or family functioning, leaving gaps in the literature. The review concludes with discussions of the Great Recession and whether effects found during stronger economic times generalize to the most recent economic crisis, and with a discussion of social safety net policies in countries outside the United States.
Child Development Perspectives 09/2013; 7(3). DOI:10.1111/cdep.12037 · 3.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives:
We examined preventive care use by nonelderly adults (aged 18-64 years) before the Affordable Care Act (ACA) and considered the contributions of insurance coverage and other factors to service use patterns.
We used data from the 2005-2010 Medical Expenditure Panel Survey to measure the receipt of 8 recommended preventive services. We examined gaps in receipt of services for adults with incomes below 400% of the federal poverty level compared with higher incomes. We then used a regression-based decomposition analysis to consider factors that explain the gaps in service use by income.
There were large income-related disparities in preventive care receipt for nonelderly adults. Differences in insurance coverage explain 25% to 40% of the disparities in preventive service use by income, but education, age, and health status are also important drivers.
Expanding coverage to lower-income adults through the ACA is expected to increase their preventive care use. However, the importance of education, age, and health status in explaining income-related gaps in service use indicates that the ACA cannot address all barriers to preventive care and additional interventions may be necessary.
American Journal of Public Health 01/2014; 104(12). DOI:10.2105/AJPH.2013.301569 · 4.55 Impact Factor
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