Child/Adolescent Health

Concerns about SCHIP expansions crowding out private insurance are not borne out in New York

Concerns that middle-class families might be using the State Children's Health Insurance Program (SCHIP), when they could have private insurance for their children, was a major point of contention in Federal SCHIP reauthorization. However, a recent study of New York State SCHIP families showed that this crowd-out of private insurance due to expanded income eligibility for SCHIP is not occurring frequently. SCHIP offers coverage to children in families who earn too much to qualify for Medicaid yet cannot afford private health insurance, and would otherwise remain uninsured.

To examine crowd-out in New York, researchers used State SCHIP files to identify new enrollees from November 1, 2000 to March 31, 2001. They used sampling methods designed to represent all SCHIP enrollees in New York State. Then, by interviewing parents of new SCHIP enrollees, they assessed enrollees' prior insurance coverage and reasons for its loss, estimated the incidence of crowd-out, and identified associations between crowd-out and enrollee characteristics such as age, race/ethnicity, and overall health status.

Of the 2,644 children studied, 62 percent of SCHIP enrollees had been uninsured for a year or more and a third had never had any insurance before SCHIP. Overall, 28 percent of SCHIP enrollees lost private insurance in the 6 months prior to entering SCHIP. Yet only 7.1 percent of children enrolled in SCHIP due to crowd-out of private insurance—similar to the crowd-out rate reported in a 10-State study. Reasons other than crowd-out, such as parental job change or loss, were the dominant reason for loss of private coverage, affecting nearly a third of all SCHIP enrollees.

In addition, 10 percent of all enrollees lost prior coverage because an employer terminated health coverage options either altogether (7 percent) or just for children (3 percent). These are children who lack private insurance options and would be otherwise uninsured—the target population for SCHIP. The study was supported by the Agency for Healthcare Research and Quality (HS10450).

See "Crowd-out in the State Children's Health Insurance Program (SCHIP): Incidence, enrollee characteristics and experiences, and potential impact on New York's SCHIP," by Laura P. Shone, Dr.P.H., M.S.W., Paula M. Lantz, Ph.D., M.S., Andrew W. Dick, Ph.D., and others, in the February 2008 HSR: Health Services Research 43(1), Part II, pp. 419-434.

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