AcademyHealth2010 kenney


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AcademyHealth2010 kenney

  1. 1. Health Reform in Massachusetts: Impacts on Coverage for Children Genevieve Kenney G i K Sharon Long Adela Luque Sunday, June 27, 2010 AcademyHealth Annual Research Meeting Boston, Boston MA Funded by the Robert Wood Johnson Foundation and The SHARE Project URBAN INSTITUTE
  2. 2. Road Map • Research Questions • Data and Methods • Key Findings • I li i Implications • Conclusions URBAN INSTITUTE
  3. 3. Key Research Questions • What impact did Massachusetts Health Reform have on uninsurance rates of children? h i f hild ? • What were impacts in on type of coverage for children? • H did health reform affect coverage of lower- How h lh f ff fl and higher-income children and those newly eligible for MassHealth? li ibl f M H l h? URBAN INSTITUTE
  4. 4. Massachusetts Health Reform • Enacted comprehensive health reform in April 2006: new subsidized health insurance program for low income low-income parents; insurance market reforms and an insurance exchange; new requirements on employers; an individual mandate on coverage for adults d t f d lt • Affected coverage of children both directly through their expanded eligibility for subsidized coverage and indirectly through their parent’s insurance coverage – MassHealth expanded coverage to children with family incomes between 200 and 300 percent FPL b t d t – Strong Outreach and Enrollment Efforts URBAN INSTITUTE
  5. 5. Data • Annual Social and Economic Supplement to the Current Population Survey (CPS) from 2005-2009 – Data cover 2004-2008 • Nationally representative survey that provides data on health insurance coverage, labor force characteristics, household composition, demographic and geographic characteristics • The analysis sample includes children ages 0-18 in MA and comparison states • Coverage Categories: Uninsurance; Public (MassHealth) and Nongroup/other together and separately; Employer-sponsored Coverage URBAN INSTITUTE
  6. 6. Methods • Models include child, family, and parent control variables • Linear probability models estimated for low (less than 300 percent FPL) and higher-income children (greater than 300 percent FPL) – Estimates for subcategories <200 and 200-300 percent FPL • Difference-in-differences estimates for pre-post models with a comparison group – Comparison group: higher income children in NE states or children in comparable states not making coverage changes for parents (i.e., MN and bl ki h f (i d WA) – Pre-period defined as 2004-06; Post-period defined as 07/08 • Sensitivity analyses conducted to assess robustness of estimates URBAN INSTITUTE
  7. 7. Changes in Insurance Coverage for Children in Ch i I C f Child i MA, Overall and by Family Income Pre-reform Post-reform period period Difference Uninsured 4.6% 4 6% 1.8% 1 8% -2.8** 2 8** Public and 21.7% 26.7% 5.0* nongroup Employer- 73.7% 71.5% -2.2 sponsored Uninsurance by Family Income Lower- 8.2% 3.0% -5.2** income Higher- 1.8% 0.9% -0.9 income * p<0 10 ** p<0 05 p<0.10, p<0.05 Source: ASEC to the CPS, 2005 2009 2005-2009 URBAN INSTITUTE
  8. 8. Difference-in-Differences Difference in Differences Estimates Impacts of Health Reform on Children’s Insurance Coverage in MA, Overall and by Family Income All Lower-income Higher-income Uninsured -2.7** -5.2** -1.0 Public 3.2 7.7* -0.8 Nongroup -2.8 -2 8* -3.4 -3 4* -2.3 -2 3 Employer- sponsored 2.3 0.8 4.1* * p<0.10, ** p<0.05 Source: ASEC to the CPS, 2005-2009 URBAN INSTITUTE
  9. 9. Difference-in-Differences Difference in Differences Estimates Effects of Health Reform on Lower-Income Children’s Insurance Coverage in MA, by Eligibility for MassHealth Eligible for Newly Eligible MassHealth for MassHealth before reform under reform Uninsured -5.1* -6.4** Public 10.4* 3.9 Nongroup -3.6* -2.2 p y Employer- -1.7 17 4.6 46 sponsored * p<0.10, ** p<0.05 Source: ASEC to the CPS, 2005-2009 URBAN INSTITUTE
  10. 10. Sensitivity Analysis • Obtained similar findings using alternative comparison groups (e.g., children in MN and WA) (e g • Also obtained similar findings excluding 2006, a transition year excluding non-citizen children, year, non citizen children and using a propensity score approach to reweighting the comparison group • Robust findings, but still reliant on non- findings non experimental design…. URBAN INSTITUTE
  11. 11. Conclusions • Health Reform in MA cut uninsurance rate in half for kids: f kid – Just 1.8 percent of all kids and 3.0 percent of low- income children are uninsured i hild i d • No apparent substitution of Public Coverage for ESI • Access to care likely increased for children due to reductions in uninsurance and non-group coverage URBAN INSTITUTE
  12. 12. Implications for Federal Health Reform • National health reform law contains many of the same elements as Massachusetts health reform • Majority of uninsured children nationwide are eligible for Medicaid/CHIP but not enrolled – Experience in MA suggests that increasing take-up of p gg g p public coverage is possible even when uninsured rates among eligible children are already high – Policy changes that address enrollment/retention barriers and coverage gaps for parents may be critical URBAN INSTITUTE
  13. 13. Genevieve Kenney Senior Fellow Health Policy Center Urban Institute (202) 261-5568 URBAN INSTITUTE