University of Maryland, College Park, MD.
York University, Toronto, ON, M3J 1P3, Canada.
Am Econ Rev. 2009 May;99(2):522-6. doi: 10.1257/aer.99.2.522.
The past 20 years have seen important changes in public policy with the potential for significant impacts on health insurance for children. These changes included both those explicitly intended to expand access to public insurance for children, including expansions in eligibility for Medicaid and the introduction of the State Children’s Health Insurance Program (SCHIP), and other changes in antipoverty policy. Since health insurance coverage among children is entwined with parental welfare participation and employment, shifts in policy designed to encourage work in place of welfare participation--such as welfare reform and the expansion of the Earned Income Tax Credit (EITC)--may have secondary impacts on children's health insurance coverage. As parents leave welfare, with its guaranteed health insurance through Medicaid, for jobs that may or may not have health insurance coverage offered as a benefit, children may experience a change in the source of their health insurance coverage or may become uninsured. Similarly, changes in health care markets and economic conditions such as rising health care prices and cyclicality in the availability of employment may also affect children's coverage. Despite the potential importance of these factors for coverage, the fraction of children who are uninsured has remained largely constant, particularly through the 1990s. However, this relatively constant level of uninsurance may mask changes in the underlying dynamics of health insurance among children. In this paper, we use monthly data from the 1986–1996 panels of the Survey of Income and Program Participation (SIPP) to examine patterns of health insurance coverage among children during the period 1986–1999, focusing on transitions between public coverage, private coverage, and no coverage. Using these data, we find that over the 1990s the rate of transitions among all three insurance states--public insurance, private insurance, and no insurance--increased, with a particular increase in transitions involving public coverage. We investigate whether there is evidence of a relationship between insurance transitions and various policy and economic variables, focusing on the impacts of expansions in public coverage availability, the effects of other policies directed at the poor that affect employment and insurance coverage, and economic conditions. We find that several of the policy changes that took place over the 1990s had important effects on health insurance transitions for children.
过去 20 年来，公共政策发生了重大变化，这些变化有可能对儿童医疗保险产生重大影响。这些变化既包括那些明确旨在扩大儿童公共保险覆盖面的变化，如扩大医疗补助计划（Medicaid）的资格范围和引入儿童健康保险计划（SCHIP），也包括扶贫政策的其他变化。由于儿童的医疗保险覆盖范围与父母的福利参与和就业情况交织在一起，因此旨在鼓励人们参加工作而不是领取福利的政策变化——如福利改革和扩大劳动所得税收抵免（EITC）——可能会对儿童的医疗保险覆盖范围产生次要影响。随着父母离开福利，即通过医疗补助获得有保障的医疗保险，转而从事可能有或可能没有医疗保险福利的工作，儿童可能会经历医疗保险来源的变化，或者变得没有医疗保险。同样，医疗保健市场和经济状况的变化，如医疗保健价格上涨和就业机会的周期性变化，也可能影响儿童的保险覆盖范围。尽管这些因素对覆盖范围可能很重要，但在整个 1990 年代，未参保儿童的比例基本保持不变。然而，这种相对稳定的未参保水平可能掩盖了儿童医疗保险基本动态的变化。在本文中，我们使用收入和计划参与调查（SIPP）1986-1996 年面板的月度数据，考察了 1986-1999 年期间儿童医疗保险覆盖范围的模式，重点是公共覆盖、私人覆盖和无覆盖之间的转变。利用这些数据，我们发现，在整个 1990 年代，所有三种保险状态（公共保险、私人保险和无保险）之间的转变率都有所增加，特别是涉及公共保险的转变率增加了。我们调查了保险转变与各种政策和经济变量之间是否存在关系的证据，重点关注公共覆盖范围扩大的影响、针对贫困人口的其他政策的影响，这些政策影响就业和保险覆盖范围，以及经济状况。我们发现，1990 年代发生的几项政策变化对儿童医疗保险的转变产生了重要影响。
