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An Interrupted Time Series Multivariate Regression Analysis Evaluation of State Children's Health Insurance Programs (SCHIP) by Whitney Bowman-Zatzkin, MPA, MSR
As health insurance premiums continue to rise, the ability of many families to provide the critical health coverage to their children (both preventative and emergency) becomes an even greater challenge. In a study released in February 2005 in the Journal of Health Affairs, researchers found that half of those surveyed listed medical bills as the reason for their bankruptcy filings, with 75.7 percent of that half citing issues with health insurance during the illness resulting in the grandiose bills (Himmelstein, 2005). Figures released in 1997 from the Census Bureau reported a minimum of 10.7 million non-insured children within the United States (U.S. Bureau of the Census, 1997). The State Children’s Health Insurance Program (SCHIP) was developed to address these concerns.
SCHIP has been implemented as a supplemental Medicaid program for eligible children based on financial need. The original focus of SCHIP was to provide healthcare coverage to all children from birth to six years of age and having family incomes up to 133 percent of the Federal poverty level (FPL) while also covering children age six and over with family incomes at or above 100 percent of FPL. The goal was to have all children living below established poverty levels and under the age of 19 eligible for coverage by September 2002.
States could choose from the following implementation options.
1. Use SCHIP funding and expand their established Medicaid program to accommodate a larger percentage of children (Expansion Program).
2. Create a program for a new bracket of uninsured children, separate from Medicaid (New Program).
3. Combine the established Medicaid program with a new program offering separate enrollment options (Combination).
States are permitted to divert funds from other resources to provide healthcare to children under very loosely defined parameters. At the time, there was no children’s healthcare program with the strength and financial backing of SCHIP.
This paper evaluates the success of the SCHIP program and whether the choice of implementation design influences its success. SCHIP is currently under consideration for reauthorization making such an evaluation very timely. This paper proceeds as follows. First, I provide background about the SCHIP program. Next, I describe my research design and methods. Then I discuss my findings. Finally, I conclude with a discussion of my results.