This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health,

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Presentation transcript:

This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA Sub-Contract Research Corporation of the University of Hawaii, Project No Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation. Hawai ì ’s Uninsured Population: Children Age 0-18 Gerard Russo Sang-Hyop Lee Lawrence Nitz University of Hawaiì at Mānoa Hawaiì Coverage for All Project IV Technical Workshop 26 September 2003

Preliminary results. Please do not quote. Data Sources Current Population Survey March Demographic Supplement Hawaii Health Survey 2000, 2001

26 September 2003Preliminary results. Please do not quote. Age Distribution of Hawaii’s Uninsured Population: CPS

26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 with 95% Confidence Interval: Hawaii Health Survey 2000, 2001; Current Population Survey

26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by County with 95% Confidence Interval: Hawaii Health Survey 2001

26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by County: CPS

26 September 2003Preliminary results. Please do not quote. Percent Uninsured, Children Age 0-18 by FPL: CPS

26 September 2003Preliminary results. Please do not quote. Insured and Uninsured Children Age 0-18 by FPL: CPS

26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by Eligibility for Free Medical Assistance: CPS

26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by FPL: CPS , HHS 2001

This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA Sub-Contract Research Corporation of the University of Hawaii, Project No Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation. Expansion of the State Children’s Health Insurance Program (SCHIP) Gerard Russo Sang-Hyop Lee Lawrence Nitz University of Hawai`i at Mānoa Hawai`i Coverage for All Project IV Technical Workshop 26 September 2003

This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health, Prime Contract No. 1 P09 OA Sub-Contract Research Corporation of the University of Hawaii, Project No Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs/Hawaii Uninsured Project and the Hawaii Health Information Corporation. POLICY SCENARIO: SCHIP EXPANSION Expand the eligibility requirement for the State Children’s Health Insurance Program for children aged 0-18 years from an upper limit of 200% to 300% of the Federal Poverty Level.

26 September 2003Preliminary results. Please do not quote. Social Security Amendments Medicare: Title XVIII of the Social Security Act 1965 Medicaid: Title XIX of the Social Security Act 1965 SCHIP: Title XXI of the Social Security Act 1997

26 September 2003Preliminary results. Please do not quote. Hawaii Title XXI Program: SCHIP January 2000 SCHIP Hawaii children aged 1 to 5 years 185% FPL effective. July 2000 SCHIP Hawaii children aged 0 to 18 years 200% of the FPL effective. Hawaii SCHIP is implemented as a Medicaid/QUEST expansion.

26 September 2003Preliminary results. Please do not quote. Hawaii SCHIP Program Eligibility by Age and Federal Poverty Level

26 September 2003Preliminary results. Please do not quote. Hawaii SCHIP Enrollment FFY 2001: 7,137 FFY 2002: 8,474

26 September 2003Preliminary results. Please do not quote. SCHIP FMAP Federal Medical Assistance Percentage (FMAP) FFY % FFY %

26 September 2003Preliminary results. Please do not quote. Insurance Coverage by FPL: Children Age 0-18.

26 September 2003Preliminary results. Please do not quote. Insurance Coverage Rates by FPL: Children Age 0-18, HHS , % % % 25, % 78, % 5, %

26 September 2003Preliminary results. Please do not quote. Economic-Demographic Analysis of SCHIP Expansion How many additional children are potentially eligible under the change from 200% to 300% FPL? 49,335 based on HHS ,144 based on pooled HHS ,121 based on pooled CPS Of the newly eligible children, how many are expected to be enrolled in SCHIP? (Take-Up) Of the newly enrolled SCHIP beneficiaries, how many are expected to have switched from private to public insurance? (Crowd-Out) How many children will become newly insured?

26 September 2003Preliminary results. Please do not quote. Incurred Per Capita Expenses 2001: Uninsured Children Age 0-18, % FPL Emergency Room & Hospital Inpatient Discharge $188 Hospital Operated Clinics? Private Physician Offices? Primary Care Facilities? Pharmaceuticals, etc.? TOTAL$188

26 September 2003Preliminary results. Please do not quote. Economic Cost Analysis What is the expected direct expenditure per newly enrolled beneficiary? Burden to Federal Taxpayers Burden to State Taxpayers What is the current total medical expenditure by all sources per uninsured child residing in households % of FPL? $188

26 September 2003Preliminary results. Please do not quote. Economic Cost Analysis (cont.) What is the cost per newly insured child? Cost to Federal Taxpayers Cost to State Taxpayers Cost to Society as a Whole What is the total cost of the SCHIP expansion? Cost to Federal Taxpayers Cost to State Taxpayers Cost to Society as a Whole

26 September 2003Preliminary results. Please do not quote. Analysis of the previous SCHIP Expansion 1998, 1999 HHS: Pre-Expansion 2000 HHS: SCHIP Expansions, January 1, 2000 and July 1, , 2002 HHS: Post-Expansion The HHS is Quasi-Experimental Data Treatment Group: Age 0, %; Age 1-5, %; Age 6-18, % FPL. Control Group: Age 0-18, % FPL.

26 September 2003Preliminary results. Please do not quote. Possible Outcomes of SCHIP Expansion Case I: No one enrolls Expansion is a failure. State cost is low. Case II: Only uninsured children enroll new children insured Direct cost: Federal 71.14%; State 28.86% Health care industry receives modest enhanced revenue Case III: Everybody enrolls Public insurance displaces private coverage Direct public expense per newly insured child is high: Federal 71.14%; State 28.86% Public financing (71.14% federal subsidy) displaces private financing (15-30% federal tax-subsidy) Household incomes are enhanced (secondary tax effect) Health care industry revenues are enhanced Private insurers switch supply from private product to QUEST product