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Does Public Health Insurance for Children Improve Single Mothers’ Health Care Use?

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Abstract

Public health insurance expansions for low- and middle-income children have improved private and social welfare by enhancing children’s access to socially-valued health services and improving their health. In this paper, we considered another welfare implication from expanded public coverage for children: Whether the savings in private insurance premiums and/or out-of-pocket medical spending from enrolling children in public coverage freed up income that was used for mothers’ own medical care. We used data from the 2001–2008 US Medical Expenditure Panel Survey and found that uninsured, low-income single mothers with children enrolled in public coverage used more preventive and other health care services than their counterparts who did not enroll their children in such coverage.

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Notes

  1. Under the ACA, most private health insurers (except grandfathered health plans) and Medicare are required to cover preventive services designated “A” and “B” by the US Preventive Services Task Force. For a list of such services see: http://www.uspreventiveservicestaskforce.org/uspstf/uspsabrecs.htm.

  2. Although estimates and methodological approaches vary, the high end of such estimates found that crowd out—the increase in public coverage attributable to a decline in ESI—ranged from between a third to nearly 60 % (see Davidson et al. 2004; Gruber and Simon 2008 for reviews of the literature). In more recent work, Zimmer (2010) found that nearly a third of children enrolled in the State Children’s Health Insurance Program were in families with two privately insured parents.

  3. Apart from dropping dependent coverage, we assumed that parents did not change the nature of the health insurance they obtained (i.e., moving to coverage that is less generous) but only switched from family to employee-plus-one or single coverage. While not directly comparable, our analysis is consistent with the increased willingness to pay for health services (i.e., efficient moral hazard) and thus the enhanced private and social welfare that would result from the income transfers individuals in poor health received from other members in their insurance pool (Nyman 2002, 2004).

  4. Other sample restrictions are described below in the data section.

  5. The restrictions on our samples resulted in the exclusion of 3.7 % of the sample for uninsured mothers and 9.6 % of the sample for ESI mothers.

  6. The private out-of-pocket premiums were collected directly in the MEPS questionnaire. The public premiums for children enrolled in public coverage were estimated based on state-level data on eligibility criteria and required premiums.

  7. We did not include a direct measure of out-of-pocket spending on children’s health care in our models for uninsured mothers. As noted above, children on public coverage were likely to use more medical services than uninsured children. As a result, comparing their out-of-pocket spending would not appropriately reflect the savings a mother would expect when enrolling her children on public coverage.

  8. In both descriptive and econometric analyses, our estimates were weighted to yield population estimates of use and so that regression coefficients reflected the behavior of the population under consideration. We also adjusted standard errors for the complex survey design of the MEPS.

  9. We did not estimate a conditional expenditure equation for mental health prescription drugs due to small sample sizes.

  10. The job characteristics included in these models reflected the last job in the calendar year. In the models estimated on uninsured mothers, we included controls for women who worked the whole year, part-of-the year, or not at all.

  11. We are grateful to Kosali Simon for providing us with the latter measure.

References

  • Banthin, J., & Selden T. (2003). The ABC’s of children’s health care: How the Medicaid expansions affected access, burdens, and coverage between 1987 and 1996. Inquiry, 40(2), 133-45. Retrieved from http://inq.sagepub.com/content/40/2/133.

  • Currie, J., Decker, S., & Lin, W. (2008). Has public health insurance for older children reduced disparities in access to care and health outcomes? Journal of Health Economics, 27(6), 1567–1581. doi:10.1016/j.jhealeco.2008.07.002.

    Article  Google Scholar 

  • Currie, J., & Gruber, J. (1996a). Health insurance eligibility, utilization of medical care, and child health. Quarterly Journal of Economics, 111(2), 431–466. Retrieved from http://www.jstor.org/stable/2946684?origin=JSTOR-pdf.

  • Currie, J., & Gruber, J. (1996b). Saving babies: The efficacy and cost of recent expansions of Medicaid eligibility for pregnant women. Journal of Political Economy, 104(6), 1263–1296. Retrieved from http://www.jstor.org/stable/2138939?origin=JSTOR-pdf.

  • Cutler, D., & Gruber, J. (1996a). Does public insurance crowd out private insurance? Quarterly Journal of Economics, 111(2), 391–430. Retrieved from http://www.jstor.ort/stable/2946683?origin=JSTOR-pdf.

  • Cutler, D., & Gruber, J. (1996b). The effect of Medicaid expansions on public insurance, private insurance, and redistribution. American Economic Review Papers and Proceedings, 86(2), 378–383. Retrieved from http://www.jstor.org/stable/2118156?origin=JSTOR-pdf.

  • Cutler, D., & Gruber, J. (1997). Medicaid and private insurance: Evidence and implications. Health Affairs, 16(1), 194–200. doi:10.1377/hlthaff.16.1.194.

    Article  Google Scholar 

  • Davidson, G., Blewett, L., & Call, K. (2004). Public program crowd-out of private coverage: What are the issues? (The Synthesis Project: New Insights from Research Results, Policy Brief No. 5). Retrieved from the State Health Access Data Assistance Center website: http://www.shadac.org/files/CrowdOut_Report_Jun04.pdf.

  • Gruber, J. (2003). Medicaid. In R. A. Moffitt (Ed.), Means-tested transfer programs in the United States (pp. 15–78). Chicago, IL: University of Chicago Press.

    Chapter  Google Scholar 

  • Gruber, J., & Simon, K. (2008). Crowd-out ten years later: Have recent public insurance expansions crowded out private health insurance? Journal of Health Economics, 27(2), 201–217. doi:10.1016/j.jhealeco.2007.11.004.

    Article  Google Scholar 

  • Hill, S. (2012). Individual insurance benefits to be available under health reform would have cut out-of-pocket spending in 2001–2008. Health Affairs, 31(6), 1349–1356. doi:10.1377/hlthaff.2011.1206.

    Article  Google Scholar 

  • Leininger, L., Levy, H., & Schanzenbach, D. (2010). Consequences of SHIP expansions for household well-being. Forum for Health Economics and Policy, 13(1), Article 3. doi:10.2202/1558-9544.1201.

  • Miller, G. E., & Pylypchuk, Y. (2014). Marital status, spousal characteristics, and the use of preventive care. Journal of Family and Economic Issues, 35, 323–338. doi:10.1007/s10834-013-9375-y.

    Article  Google Scholar 

  • Monheit, A., & Vistnes, J. (2005). The demand for dependent health insurance: How important is the cost of family coverage? Journal of Health Economics, 24(6), 1108–1131. doi:10.1016/j.jhealeco.2005.04.005.

    Article  Google Scholar 

  • Nyman, J. (2002). The theory of demand for health insurance. Stanford, CA: Stanford University Press.

    Google Scholar 

  • Nyman, J. (2004). Is moral hazard inefficient? The policy implications of a new theory. Health Affairs, 23(5), 317–318. doi:10.1377/hlthaff.23.5.194.

    Article  Google Scholar 

  • Schaefer, H., Colleen, L., Grogan, M., & Pollack, H. (2011). Transitions from private to public health coverage among children: Estimating effects on out-of-pocket medical costs and health insurance premium costs. Health Services Research, 46(3), 840–858. doi:10.1111/j.1475-6773.2010.01238.x.

    Article  Google Scholar 

  • Snyder, L., Rudowitz, R., Garfield, R., & Gordon, T. (2012). Why does Medicaid spending vary across states: A chartbook of factors driving state spending (Kaiser Commission on Medicaid and the Uninsured Issue Paper #8378). Retrieved from The Kaiser Family Foundation website: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8378.pdf.

  • Ver Ploeg, M. (2009). Do benefits of US food assistance programs for children spillover to older children in the same household? Journal of Family and Economic Issues, 30, 412–427. doi:10.1007/s10834-009164-9.

    Article  Google Scholar 

  • Vistnes, J., & Schone, B. (2008). Pathways to coverage: The changing role of public and private sources. Health Affairs, 27(1), 44–57. doi:10.1377/hlthaff.27.1.44.

    Article  Google Scholar 

  • Zimmer, D. (2010). The effects of the State Children’s Health Insurance Program on insurance status and health care utilization of children. Journal of Family and Economic Issues, 32, 373–383. doi:10.1007/s10834-010-9235-y.

    Article  Google Scholar 

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Correspondence to Alan C. Monheit.

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Monheit, A.C., Vistnes, J. Does Public Health Insurance for Children Improve Single Mothers’ Health Care Use?. J Fam Econ Iss 36, 581–592 (2015). https://doi.org/10.1007/s10834-014-9430-3

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