Schip Is Available to Families With Incomes Up to ______ of the Federal Poverty Level.
Acad Pediatr. Author manuscript; available in PMC 2017 Apr one.
Published in final edited form every bit:
PMCID: PMC5034870
NIHMSID: NIHMS815382
The Part of Public Health Insurance in Reducing Child Poverty
Laura R. Wherry
aDivision of General Internal Medicine & Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Avenue, Room 226, Los Angeles, CA 90024
Genevieve M. Kenney
bHealth Policy Center, Urban Establish, 2100 M Street NW, Washington, DC
Benjamin D. Sommers
cDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Kresge Building, Room 406, 677 Huntington Avenue, Boston, Massachusetts 02115
Abstruse
Over the final thirty years, in that location have been major expansions in public health insurance for low-income children in the U.S. through Medicaid, the Children's Wellness Insurance Program (CHIP), and other state-based efforts. In add-on, many low-income parents accept gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the inquiry to date on health insurance coverage amid low-income populations has focused on its touch on on wellness care utilization and health outcomes, with much less attention to the financial protection it offers families. Nosotros review a growing body of show that public health insurance provides of import financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out-of-pocket medical spending, increased financial stability, and improved fabric well-being for families. We also review the potential poverty-reducing furnishings of public health insurance coverage. When out-of-pocket medical expenses are taken into business relationship in defining the poverty charge per unit, Medicaid plays a pregnant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such equally food assistance programs that also assistance reduce poverty. Nosotros conclude by reviewing emerging bear witness that admission to public health insurance in childhood has long-term furnishings for both health and economic outcomes in machismo. Exposure to Medicaid and Fleck during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support afterwards in life. In sum, the nation's public wellness insurance programs have many important brusk and long-term poverty-reducing benefits for low-income families with children.
Keywords: Medicaid, CHIP, public wellness insurance, poverty
Introduction
The link between poor health and poverty has been well documented and the relationship is complex. Not only is poverty a contributing gene to poor health outcomes, but people in poor health often have depression incomes as a effect of their health problems. The financial brunt of medical intendance, measured equally out-of-pocket spending relative to full family income, is substantially higher for low-income families with children than for families with higher incomes and for families that have children or other family unit members with special health intendance needs.1–2 More than a quarter of poor families with children have total out-of-pocket expenditures exceeding 10% of family income,ane a threshold unremarkably used to capture catastrophic spending or being "underinsured."
Past subsidizing many of the costs associated with medical care, public health insurance can play a critical office in improving the financial well-being of low-income families with children. Over the last thirty years, there accept been major expansions in public health insurance for low-income children in the U.S. under Medicaid and the Children's Wellness Insurance Program (Chip). In addition, millions of low-income parents have gained coverage through the Medicaid expansion and subsidies bachelor for marketplace coverage under the Affordable Care Act (ACA). In this article, we provide an overview of the public health insurance options available for poor and low-income families with children, and so review the evidence connecting public wellness insurance to financial and economic outcomes for families. We also talk over the role of public health insurance in reducing poverty in the U.Due south. We conclude with a review of emerging evidence indicating that health insurance coverage during babyhood may help mitigate the harmful effects of childhood poverty afterwards in life. Table 1 presents a summary of the main themes discussed in this article.
Table 1
The Role of Public Health Insurance in Improving Family Financial Well-Beingness
| Key Lesson | Enquiry Findings | Sources |
|---|---|---|
| Public health insurance provides fiscal protection to families |
| Finkelstein et al. (fourteen) McMorrow et al. (15) Baicker et al. (17) Banthin and Selden (21) Davidoff, Kenney, and Dubay (22) Leininger, Levy, and Schanzenbach (23) Clemans Cope et al. (24) Zickafoose, Smith, and Dye (25) Shaefer, Grogan, and Pollack (26) Gross and Notowidigio (27) Gruber and Yelowitz (28) |
| Fewer families live in poverty as a result of decreased out-of-pocket medical spending under public health insurance |
| Sommers and Oellerich (xxx) |
| Public health insurance connects families to other social support programs |
| Baicker et al. (31) Yelowitz (32) |
| Public health insurance for children influences long-term wellness and economic outcomes |
| Boudreaux, Golberstein, and McAlpine (33) Wherry and Meyer (34) Wherry et al. (35) Currie, Decker, and Lin (36) Chocolate-brown, Kowalski, and Lurie (37) Miller and Wherry (38) Levine and Schanzenbach (39) Cohodes et al. (40) |
Health Insurance Options for Low-Income Families
To address disparities in kid healthcare, U.S. policy has primarily focused on increasing access to medical care for children through expansions in eligibility for public health insurance. From the onset of the program in 1965, Medicaid coverage for non-disabled children was tied to family participation in the nation's cash help program. Beginning in 1984, Congress took steps to de-link the Medicaid and cash aid programs and expand Medicaid eligibility to children with family incomes at or below the federal poverty level (FPL) and to 133% of the FPL for children and infants under age six.
In 1997, the Children'south Health Insurance Program (Fleck) was created to address coverage gaps for children whose families had incomes that were too high to qualify for Medicaid but too little to beget private health insurance coverage.3 Under Fleck, states could expand coverage to higher income children through Medicaid, a separate non-Medicaid program, or a combination of both. While CHIP was funded as a block grant and non as an entitlement similar Medicaid, states received college federal matching funds nether CHIP and had more latitude over programmatic pattern features. Fleck also included policies designed to increase accept up of Medicaid and Scrap coverage among uninsured children who were eligible but non enrolled, allowing states to disregard asset tests, eliminate face-to-face interview requirements, and grant children presumptive eligibility. The Children's Health Insurance Programme Reauthorization Act (CHIPRA) of 2009 provided states with additional options for increasing take upwardly of Medicaid and Flake. Nether Medicaid and Scrap, xx-viii states currently embrace children in families with incomes at or higher up 250% of the Federal Poverty Level (FPL), while 18 states and D.C. cover children with family incomes at or above 300% FPL, with a national median of 255% FPL.iv
Equally a result of these eligibility expansions and related policy changes, the Medicaid and Scrap programs play a major part in the wellness insurance coverage of children in the U.South. In 2011, 38% of all children were enrolled in Medicaid or CHIP.v Furthermore, the proportion of children without health insurance coverage declined essentially over this period from fifteen% in 1984 to half dozen.vi% in 2012, even every bit the uninsured rate for non-elderly adults climbed.5 Effigy 1 shows desperate changes in rates of insurance and access to care for children from 1997 to 2012 by household income level. A big literature has demonstrated that expansions in Medicaid and Chip eligibility accept resulted in improved access and utilization of health care services for children, while a smaller number of studies have examined the impact on child wellness and mortality.6
Change in Rates of Insurance and Access to Care for Children from 1997 to 2012, By Household Income (percent of poverty)
Source: Rosenbaum and Kenney (8); authors' analysis of data from the 1997 and 2012 National Wellness Interview Surveys.
The majority of uninsured children are eligible for just non participating in either Medicaid or CHIP.seven However, eligibility for Medicaid and CHIP is not universal among depression-income children. Most children who are undocumented immigrants remain ineligible for these programs, and only sure groups of immigrants qualify for public coverage depending on their state of residence. In add-on, there is doubtfulness near children'due south coverage going forrard given that federal funding for the CHIP program is set to expire in 2017 and the ACA maintenance-of-effort requirement that states maintain the level of generosity of Medicaid and Scrap eligibility thresholds for children expires in 2019. Given that the ACA prevents families from receiving subsidized coverage through land marketplaces if their employer offers "affordable" coverage for the worker only non necessarily the family (i.eastward. the "family glitch"), some families who stand to lose Medicaid and Flake eligibility could observe themselves facing large financial burdens to maintain coverage for their children.eight In addition, coverage for children available under marketplace plans is typically less generous than coverage under CHIP.9
In contrast to children, public health insurance eligibility for low-income adults has historically been much more than limited. While all state Medicaid programs covered some depression-income parents prior to the ACA, income-related eligibility thresholds were quite low in many states. Equally of January 2013, only 33 states covered parents with family unit incomes upward to 100% FPL and 16 states limited eligibility to parents with incomes less than 50% FPL.10 Under the ACA's Medicaid expansion – originally intended to occur in all states, earlier the Supreme Court rendered it a state option de facto in 2012 – 30 states and the District of Columbia have chosen to expand Medicaid to adults with family unit incomes at or beneath 138% FPL equally of December 2015. In states expanding Medicaid, in that location was a sizeable increase in parental coverage immediately following the expansions with the uninsured rate dropping past 33%.eleven Parental coverage is expected to proceed to increment as more parents obtain Medicaid and subsidized coverage through the new ACA marketplaces.
Optional land expansions in Medicaid eligibility prior to the ACA, using existing flexibility in federal statute or via sit-in waivers from the federal government, provided researchers with opportunities to study the touch on of expanded coverage for depression-income adults. The landmark Oregon Health Insurance Experiment (OHIE) studied a randomized Medicaid expansion for low-income adults in Oregon conducted through a lottery. The OHIE and a number of quasi-experimental studies that examined expansions for low-income adults have found evidence of increased insurance coverage and health intendance utilization,12–16 improved full general health condition,xiv,16–17 improve mental health,fourteen–15,17 and reduced mortality.xvi In addition, there is significant evidence that predates the ACA that parental Medicaid coverage is an important determinant of whether eligible children enroll in coverage.12,18–twenty
Fiscal Benefits of Expanded Health Insurance Coverage
To appointment, most of the inquiry on health insurance coverage among low-income populations has focused on its affect on health intendance utilization and health outcomes, with much less attending to the financial protection it offers families. Still, the primary economic purpose of insurance, in general, is to protect those covered from financial risk. In the case of wellness insurance, these risks take the class of becoming sick or injured and needing expensive medical intendance. Health insurance – specially generous coverage with trivial toll-sharing, every bit in Medicaid and CHIP – may also aid with the affordability of non-catastrophic medical care, such as routine preventive care and chronic disease direction. A modest but growing number of quasi-experimental and experimental studies point that expanded health insurance coverage provides of import financial benefits to the low-income or uninsured families who proceeds coverage.
Three papers accept employed quasi-experimental methods to show reduced family unit financial burdens associated with expanded child eligibility for public wellness insurance. Using a difference-in-differences design, Banthin and Selden establish that child Medicaid expansions in the 1990s decreased the share of Medicaid-eligible children in families spending x% or more of their income on medical care and premiums past 7.4 percentage points (a relative reduction of 25%) when compared to higher income children.21 Davidoff, Kenney, and Dubay used a like research pattern and found that eligibility expansions occurring nether Chip betwixt 1997 and 2001 were associated with lower out-of-pocket spending levels on wellness intendance.22 Finally, Leininger, Levy, and Schanzenbach examined the affect of later expansions under CHIP relying on a natural experiment design that used variation across states and time in CHIP-related eligibility expansions.23 The authors found that child eligibility for Bit was associated with a dramatic decline in family unit spending on insurance and medical care of about $300 to $400 per quarter, compared to a baseline spending corporeality of $457.
Several additional studies have focused on children who switch to public health insurance from either private insurance coverage or being uninsured and demonstrate decreased fiscal strain for families. Clemans Cope et al. used a survey of parents of children participating in Flake to compare the experiences of families of established CHIP enrollees and the newly enrolled.24 Parents of established Flake enrollees reported lower out-of-pocket costs and fewer difficulties paying their kid'southward medical bills when compared to the experiences of parents with recently uninsured and privately-insured children. This reduced financial brunt was accompanied by higher confidence and less worry associated with meeting their child'due south health care needs. In addition, parents of CHIP enrollees were more than likely to study adequate insurance benefits and financial protection when compared to the parents of privately-insured children. In a like study, Zickafoose, Smith, and Dye institute that parents of CHIP enrollees with special health care needs reported less difficulty in coming together these needs than parents of uninsured and privately-insured children.25
Shaefer, Grogan, and Pollack also plant testify of reduced family medical spending when children transitioned from private to public health insurance coverage.26 Using variation in Medicaid and CHIP eligibility rules across states to examine these transitions in console information, the authors estimated that families with children switching to public coverage saved $1,500 in almanac premiums and out-of-pocket costs, compared to children who remain on private health insurance throughout the year. These findings are consistent with fewer cost-sharing requirements and more comprehensive coverage under public health insurance as compared to some private plans. Nevertheless, information technology is important to carry in mind that the families who are motivated to switch to public from individual coverage are also the families near likely to do good in terms of financial or other benefits.
The available evidence too indicates reduced fiscal burden associated with public coverage for depression-income parents and adults. Using variation within states over time in the Medicaid income eligibility criteria for parents before 2010, McMorrow and coauthors estimated a significant association betwixt expanded Medicaid eligibility for depression-income parents and reduced family out-of-pocket spending for medical care.15 The authors found that low-income parents were less probable to spend $500 or more or $2,000 or more over a 12-month menstruum in states with more generous Medicaid eligibility for parents. Examining expanded Medicaid for low-income adults (including parents), the OHIE found decreased financial strain on a number of cocky-reported measures amid adults gaining Medicaid. Adults enrolled in Medicaid were 35% less likely to accept whatever out-of-pocket medical expenses and twoscore% less probable to borrow money or skip bills to pay for medical expenses.14 In addition, the incidence of catastrophic expenditures, divers every bit out-of-pocket medical expenses exceeding 40% of household income, decreased by more than fourscore% among the new Medicaid enrollees.17
Protection against catastrophic medical costs is an important benefit of health insurance and may improve the financial stability of low-income households. Recent research examines the impact of health insurance on the financial security of households using previously unexplored datasets on consumer bankruptcies and credit. Using a quasi-experimental arroyo that relied on variation within states over fourth dimension in Medicaid eligibility for significant women and children, Gross and Notowidigio establish that a 10-percentage point increment in Medicaid eligibility was associated with an 8% decrease in household defalcation.27 Their estimates implied that 26% of bankruptcies among depression-income households could exist attributed to a lack of health insurance. Additional analyses of the OHIE that relied on administrative credit report data found a 25% decrease in the probability of having unpaid medical bills sent to collections agencies for recovery attempts among low-income adults gaining Medicaid. The study found no impact, however, on more astringent (and exceptional) measures of fiscal distress including personal defalcation, tax liens, and judgments for unpaid bills.14
Finally, public health insurance programs may also improve family unit economic well-being in other ways. By subsidizing medical care for family members, public wellness insurance programs may increase the availability of household resource for non-health spending. In addition, the protection from financial risk may reduce the need for precautionary saving, in the class of asset holdings, in response to uncertainty nearly future needs. Even so, only a modest number of studies have examined changes in household savings and non-medical expenditures nether the Medicaid and Flake programs. Using variation in state Medicaid eligibility for pregnant women and children, Gruber and Yelowitz examined the affect of Medicaid expansions on changes in family unit saving and spending behavior.28 The authors establish evidence that expanded Medicaid decreased asset holdings and increased not-medical spending amid low-income families. Leininger, Levy, and Schanzenbach used a similar arroyo to analyze subsequently expansions in public insurance for children under Flake and also found evidence that depression-income households increased their expenditures on non-medical goods.23 In item, households tended to shift their spending toward transportation and retirement savings. Saloner also examined the impact of Scrap expansions on the well-beingness of families but relied on measures of textile hardships such as food and housing insecurity.29 Similar to other studies in this area, he used a quasi-experimental design that relied on variation in income eligibility cutoffs within states over time. He found no impact on these more severe measures of financial strain.
Poverty-Reducing Effects of Public Wellness Insurance
By reducing the financial brunt and risk of medical spending, public health insurance has the potential to reduce the extent to which families alive in poverty, as defined using the Supplemental Poverty Measure (SPM). Official poverty rates in the U.S. are determined past comparing pre-tax income to a standard threshold historically based on the cost of food. In response to longstanding criticisms that this mensurate does not accurately represent the needed resources or expenses of the well-nigh disadvantaged, the U.Due south. Census Bureau introduced the SPM in 2011. Notable differences between the ii measures are that (1) the SPM calculates family resources as the full of pre-taxation income and the cash-value of transfers under government assistance programs (although not public health insurance), and (two) the SPM subtracts family out-of-pocket medical spending from each family unit's resources.
Sommers and Oellerich assessed the poverty-reducing impact of Medicaid prior to the ACA under the SPM mensurate.xxx The authors modeled the counterfactual of what the medical out-of-pocket costs and poverty status would exist for individuals covered by Medicaid as of 2011 if the program did not exist. Their methodology relied on propensity score matching to compare Medicaid enrollees to those without Medicaid and randomly assigned out-of-pocket medical spending nether this counterfactual scenario based on the distribution of spending amongst matched controls. The authors plant that eliminating Medicaid would have increased the supplemental poverty charge per unit by 0.7 percentage points from 16.1% to xvi.8% in 2010. This corresponded to an additional 2.12 million people living in poverty of whom 810,000 are children. The authors calculated that, based on the SPM measure, Medicaid is the 3rd largest poverty-reducing program in the country following the Earned Income Tax Credit (EITC) and the Supplemental Diet Aid Program (SNAP). The ACA Medicaid expansions for low-income adults that take occurred since this paper was published near certainly has further increased the program's poverty-reducing effects.
In addition to decreasing out-of-pocket medical expenses, Medicaid and Fleck may besides reduce poverty by connecting families to other social support programs. Expanded enrollment in public health insurance has been shown to increase awareness of and family participation in other ways-tested public programs. The Oregon HIE constitute that enrolling in Medicaid under the lottery led to a fifteen% increase in participation in SNAP among low-income adults.31 This is consequent with an earlier quasi-experimental study by Yelowitz that found an increment in household food stamp receipt under Medicaid eligibility expansions for children in the 1980s.32
Attenuating the Long-Term Effects of Poverty
Public health insurance for depression-income children could influence their long-term outcomes past improving access to care related to chronic conditions associated with poverty. In addition, the financial benefits of Medicaid and CHIP in the form of reduced medical spending and risk protection may complimentary up resources in the household that may be directed towards other investments in children. Relying on quasi-experimental methods, a contempo literature provides new show that access to public health insurance during childhood leads to improvements in later life health and economical outcomes.
Boudreaux, Golberstein, and McAlpine took advantage of the staggered timing of Medicaid's adoption across states in the 1960s to estimate the impact of exposure to Medicaid during early on childhood on adult health and economical status at ages 25–54.33 The authors found that cohorts who gained exposure to Medicaid between conception and age 6 had significantly better adult wellness, as measured by a 0.35 standard-difference change in a composite alphabetize measure of high blood pressure, diabetes, heart affliction/heart set on, and obesity. They did non observe significant changes in an economical index combining data on years of educational attainment, family income, and wealth, but their estimates were imprecise and did not rule out reasonable effect sizes.
Other papers in this literature examine the long-term bear upon of later expansions in public health insurance for children in the 1980s and 1990s under Medicaid and Bit. Although the cohorts affected past these expansions are notwithstanding relatively young, this strand of research shows prove of promising changes in the trajectories of health and economical status in early adulthood for those gaining expanded access to Medicaid. In a series of papers, Wherry and colleagues examined the long-term health effects of additional Medicaid coverage in childhood using a natural experiment design that exploited a feature of the Medicaid expansions that extended eligibility only to children who were built-in after September 30, 1983.34–35 This resulted in a big discontinuity in the lifetime years of Medicaid eligibility for children born before and after this birthdate cutoff. They compared afterwards life bloodshed, hospitalizations, and emergency department utilise among cohorts born simply earlier and later on this date to make up one's mind how additional Medicaid eligibility was related to health in early machismo. The authors establish evidence of a decrease in teenage mortality and reduced health care utilization in early adulthood among African American cohorts gaining babyhood Medicaid eligibility.
The remaining studies in this area rely on within state variation over fourth dimension in the generosity of income eligibility thresholds for Medicaid and Fleck in order to judge the clan between childhood exposure to these programs and later life outcomes. Using a variant of a difference-in-differences design, this research plant evidence of ameliorate teenage health,36 reduced bloodshed,37 lower rates of obesity, and fewer hospitalizations and emergency section visits related to chronic conditions in early on adulthood associated with exposure to expanded public wellness insurance in childhood.38 There was too prove of improved educational attainment for cohorts gaining eligibility with higher reading test scores after in childhood and increased rates of loftier school and higher completion.38–40 Finally, 1 study establish that the U.S. government might recover some of the original cost of providing expanded Medicaid coverage. Using longitudinal Internal Revenue Service data, Brown, Kowalski, and Lurie establish that children who gained boosted years of eligibility under the expansions paid more in cumulative taxes by age 28 and were less probable to collect EITC payments than children who did not gain additional eligibility.37
Summary
Over the past ii decades, a growing trunk of literature has documented the pregnant and wide-ranging benefits of public health insurance. Expansions in Medicaid and CHIP for low-income children and adults are associated with reduced out-of-pocket medical spending, increased fiscal stability, and improved material well-being for families. When out-of-pocket medical expenses are taken into account in defining the poverty charge per unit, Medicaid plays a pregnant role in decreasing poverty for many children and families and is one of the country's largest anti-poverty programs. Public health insurance as well connects families to other social supports including food help programs. Finally, admission to public health insurance in babyhood appears to have positive long-term effects for both health and economical outcomes in machismo. Equally the nation embarks on a new major affiliate of coverage expansion nether the ACA and debate continues over the future of Fleck, this body of research provides of import evidence to inform policymakers as they counterbalance the multifaceted impacts of public health insurance programs.
Acknowledgments
Dr. Sommers' work on this project was supported in part by Grant No. K02HS021291 from the Agency for Healthcare Research and Quality (AHRQ). The authors have no financial conflicts of interest to written report. Dr. Sommers serves equally a role-fourth dimension counselor in the Office of the Assistant Secretary for Planning and Evaluation at the Department of Wellness and Human Services (HHS), but the views presented here are those of the authors and do not represent HHS or AHRQ.
Footnotes
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References
1. Galbraith AA, Wong ST, Kim SE, Newacheck PW. Out-of-Pocket Financial Burden for Low-Income Families with Children: Socioeconomic Disparities and Furnishings of Insurance. Wellness Services Research. 2005;40(6 Function I):1722–1736. [PMC complimentary commodity] [PubMed] [Google Scholar]
3. De Lew N, Epstein AM, Mann C. The Children's Health Insurance Program every bit Adolescence Ends: Nearly 2 Decades of Children's Coverage. Bookish Pediatrics. 2015;15(3, Supplement):S7–S8. [PubMed] [Google Scholar]
5. Rosenbaum S, Kenney GM. The Search for a National Child Health Coverage Policy. Health Affairs. 2014;33(12):2125–2135. [PubMed] [Google Scholar]
6. Howell EM, Kenney GM. The Impact of the Medicaid/CHIP Expansions on Children: A Synthesis of the Show. Medical Care Research and Review. 2012;20(10):1–25. [PubMed] [Google Scholar]
7. Kenney GM, Haley JM, Anderson Due north, Lynch V. Children Eligible for Medicaid or CHIP: Who Remains Uninsured, and Why? Academic Pediatrics. 2015;15(3, Supplement):S36–S43. [PubMed] [Google Scholar]
8. Rosenbaum South, Kenney GM. The Search for a National Child Health Coverage Policy. Health Affairs. 2014;33(12):2125–2135. [PubMed] [Google Scholar]
10. Heberlein Chiliad, Brooks T, Alker J, Artiga South, Stephens J. The Kaiser Commission on Medicaid and the Uninsured. Washington, DC: The Henry J. Kaiser Family unit Foundation; 2013. Getting into Gear for 2014: Findings from a 50-State Survey of Eligibility, Enrollment, Renewal, and Price-Sharing Policies in Medicaid and CHIP, 2012–2013. [Google Scholar]
11. Kenney GM, Anderson N, Long SK, Dubay L, McMorrow S, Clemens-Cope L, Karpman Thou, Wissoker D. Wellness Reform Monitoring Survey. Washington, DC: The Urban Institute; 2014. Taking Stock: Health Insurance Coverage for Parents nether the ACA in 2014. [Google Scholar]
12. Aizer A, Grogger 1000. National Bureau of Economical Research Working Paper No. 9907. 2003. Parental Medicaid Expansions and Health Insurance Coverage. [Google Scholar]
xiii. Busch SH, Duchovny Due north. Family Coverage Expansions: Affect on Insurance Coverage and Health Care Utilization of Parents. Journal of Wellness Economic science. 2005;24:876–890. [PubMed] [Google Scholar]
14. Finkelstein A, Taubman Southward, Wright B, Bernstein M, Gruber J, Newhouse JP, Allen H, Baicker K Oregon Wellness Study Group. The Oregon Health Insurance Experiment: Evidence from the Offset Year. Quarterly Journal of Economic science. 2012;127(3):1057–1106. [PMC complimentary article] [PubMed] [Google Scholar]
15. McMorrow S, Kenney GM, Long SK, Goin D, et al. How Did Medicaid Expansions to Depression-Income Parents Between 1997 and 2009 Bear on Coverage, Access to Care, and Mental Health Outcomes? Health Services Research. In Press. [Google Scholar]
16. Sommers BD, Baicker K, Epstein AM. Mortality and Access to Care among Adults subsequently State Medicaid Expansions. The New England Journal of Medicine. 2012;367:1025–1034. [PubMed] [Google Scholar]
17. Baicker K, Taubman SL, Allen HL, Bernstein M, Gruber JH, Newhouse JP, Schneider EC, Wright BJ, Zaslavsky AM, Finkelstein AN. The Oregon Experiment – Effects of Medicaid on Clinical Outcomes. New England Journal of Medicine. 2013;368(18):1713–1722. [PMC free commodity] [PubMed] [Google Scholar]
18. DeVoe JE, Marino Grand, Angier H, O'Malley JP, Crawford C, Nelson C, Tillotson CJ, Bailey SR, Gallia C, Gold R. Effect of Expanding Medicaid for Parents on Children's Health Insurance Coverage: Lessons from the Oregon Experiment Randomized Trial. JAMA Pediatrics. 2015;169(1):1–8. [PMC gratis article] [PubMed] [Google Scholar]
nineteen. Dubay L, Kenney M. Expanding Public Health Insurance to Parents: Furnishings on Children'south Coverage Under Medicaid. Health Services Inquiry. 2003;38(5):1283–1301. [PMC free article] [PubMed] [Google Scholar]
20. Sommers BD. Insuring Children or Insuring Families: Do Parental and Sibling Coverage Lead to Improved Retention of Children in Medicaid? Periodical of Health Economic science. 2006;25(6):1154–1169. [PubMed] [Google Scholar]
21. Banthin JS, Selden TM. The ABCs of Children's Health Care: How the Medicaid Expansions Affected Access, Burdens, and Coverage Between 1987 and 1996. Research. 2003;forty:133–145. [PubMed] [Google Scholar]
22. Davidoff A, Kenney One thousand, Dubay 50. Effects of the State Children'south Health Insurance Program Expansions on Children with Chronic Health Conditions. Pediatrics. 2005;116(1):e34–e42. [PubMed] [Google Scholar]
23. Leininger L, Levy H, Schanzenbach D. Consequences of SCHIP Expansions for Household Well-Existence. Forum for Health Economic science & Policy. 2010;xiii(ane):1–xxx. [Google Scholar]
24. Clemans-Cope L, Kenney G, Waidmann T, Huntress Chiliad, Anderson N. How Well is CHIP Addressing Health Care Access and Affordability for Children? Academic Pediatrics. 2015;15(3):S71–S77. [PubMed] [Google Scholar]
25. Zickafoose JS, Smith KV, Dye C. Children with Special Wellness Care Needs in Chip: Access, Utilize, and Kid and Family Outcomes. Bookish Pediatrics. 2015;xv(iii, Supplement):S85–S92. [PubMed] [Google Scholar]
26. Shaefer HL, Grogan CM, Pollack HA. Transitions from Private to Public Health Coverage amidst Children: Estimating Furnishings on Out-of-Pocket Medical Costs and Health Insurance Premium Costs. Health Services Research. 2011;46(3):840–858. [PMC free commodity] [PubMed] [Google Scholar]
27. Gross T, Notowidigdo MJ. Health Insurance and the Consumer Bankruptcy Decision: Show from Expansions of Medicaid. Periodical of Public Economics. 2011;95:767–778. [Google Scholar]
28. Gruber J, Yelowitz A. Public Health Insurance and Private Savings. Journal of Political Economy. 1999;107(vi):1249–1274. [Google Scholar]
29. Saloner B. Does Expanding Public Insurance Prevent Material Hardship for Families with Children? Medical Care Research and Review. 2013;seventy(3):267–286. [PubMed] [Google Scholar]
xxx. Sommers BD, Oellerich D. The Poverty-Reducing Outcome of Medicaid. Periodical of Health Economics. 2013;32:816–832. [PubMed] [Google Scholar]
31. Baicker G, Finkelstein A, Song J, Taubman Southward. National Bureau of Economic Research Working Paper No. 19547. 2013. The Impact of Medicaid on Labor Forcefulness Activity and Programme Participation: Evidence from the Oregon Health Insurance Experiment. [PMC complimentary article] [PubMed] [Google Scholar]
32. Yelowitz AS. UCLA Working Paper. 1996. Did Recent Medicaid Reforms Crusade the Caseload Explosion in the Food Stamp Programme? [Google Scholar]
33. Boudreaux MH, Golberstein E, McAlpine D. The Long-Term Impacts of Medicaid Exposure in Early Childhood: Show from the Programme'due south Origin. Journal of Health Economics. In Printing; available online 19 November 2015. [PMC gratuitous commodity] [PubMed] [Google Scholar]
34. Wherry L, Meyer BD. Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility. Periodical of Homo Resources. In Printing. [Google Scholar]
35. Wherry L, Miller S, Kaestner R, Meyer B. National Bureau of Economic Research Working Newspaper No. 20929. 2015. Childhood Medicaid Coverage and Later on Life Health Care Utilization. [Google Scholar]
36. Currie J, Decker S, Lin Westward. Has Public Health Insurance for Older Children Reduced Disparities in Access to Care and Wellness Outcomes? Periodical of Health Economics. 2008;27:1567–1581. [PubMed] [Google Scholar]
37. Brown DW, Kowalski AE, Lurie IZ. National Bureau of Economic Inquiry Working Paper No. 20835. 2015. Medicaid equally an Investment in Children: What is the Long-Term Affect on Taxation Receipts? [Google Scholar]
38. Miller South, Wherry LR. University of Michigan Working Paper. 2015. The Long-Term Effects of Early Life Medicaid Coverage. [Google Scholar]
39. Levine Atomic number 82, Schanzenbach D. The Bear on of Children's Public Wellness Insurance Expansions on Educational Outcomes. Forum for Wellness Economics & Policy. 2009;12(ane):1–26. [Google Scholar]
twoscore. Cohodes SR, Grossman DS, Kleiner SA, Lovenheim MF. The Result of Kid Health Insurance Access on Schooling: Show from Public Insurance Expansions. Periodical of Human Resource. In Press. [Google Scholar]
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5034870/
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