Department of Health Systems Administration, Georgetown University, Washington, DC 20057, USA.
Health Serv Res. 2013 Apr;48(2 Pt 2):884-904. doi: 10.1111/1475-6773.12039. Epub 2013 Feb 10.
To understand the effects of Children's Health Insurance Program (CHIP) income eligibility thresholds and premium contribution requirements on health insurance coverage outcomes among children.
2002-2009 Annual Social and Economic Supplements of the Current Population Survey linked to data from multiple secondary data sources.
We use a selection correction model to simultaneously estimate program eligibility and coverage outcomes conditional upon eligibility. We simulate the effects of three premium schedules representing a range of generosity levels and the effects of income eligibility thresholds ranging from 200 to 400 percent of the federal poverty line.
Premium contribution requirements decrease enrollment in public coverage and increase enrollment in private coverage, with larger effects for greater contribution levels. Our simulation results suggest minimal changes in coverage outcomes from eligibility expansions to higher income families under premium schedules that require more than a modest contribution (medium or high schedules).
Our simulation results are useful counterpoints to previous research that has estimated the average effect of program expansions as they were implemented without disentangling the effects of premiums or other program features. The sensitivity to premiums observed suggests that although contribution requirements may be effective in reducing crowd-out, they also have the potential, depending on the level of contribution required, to nullify the effects of CHIP expansions entirely. The persistence of uninsurance among children under the range of simulated scenarios points to the importance of Affordable Care Act provisions designed to make the process of obtaining coverage transparent and navigable.
了解儿童健康保险计划（CHIP）的收入资格门槛和保费缴纳要求对儿童健康保险覆盖结果的影响。
2002-2009 年美国当前人口调查年度社会经济补充调查资料，与来自多个二级数据来源的数据相链接。
我们使用选择校正模型，根据资格条件同时估计计划资格和覆盖结果。我们模拟了三种保费计划的影响，这些计划代表了一系列慷慨程度，以及从联邦贫困线的 200%到 400%不等的收入资格门槛的影响。
保费缴纳要求降低了公共保险的参保率，增加了私人保险的参保率，对于更高的缴费水平，影响更大。我们的模拟结果表明，在要求适度以上缴费（中或高计划）的保费计划下，从向较高收入家庭扩大资格范围对覆盖结果的影响很小。
我们的模拟结果是对以前研究的有用补充，以前的研究估计了计划扩大的平均影响，而没有将保费或其他计划特征的影响分开。对保费的敏感性表明，尽管缴费要求可能有效地减少排挤效应，但根据所需的缴费水平，它们也有可能完全抵消 CHIP 扩大的影响。在模拟的各种情况下，儿童仍然存在未保险的情况，这表明《平价医疗法案》的规定对于使获得保险的过程透明和易于操作非常重要。
