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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 on theme: "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,"— Presentation transcript:

1 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 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. 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 `i ’s Uninsured Population: Children Age 0-18 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

2 Preliminary results. Please do not quote. Data Sources Current Population Survey March Demographic Supplement 1996-2002 Hawaii Health Survey 2000, 2001

3 26 September 2003Preliminary results. Please do not quote. Age Distribution of Hawaii’s Uninsured Population: CPS 1996- 2002

4 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 Please do not quote.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 1996-2002

5 26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by County with 95% Confidence Interval: Hawaii Health Survey 2001

6 26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by County: CPS 1996-2002

7 26 September 2003Preliminary results. Please do not quote. Percent Uninsured, Children Age 0-18 by FPL: CPS 1996-2002

8 26 September 2003Preliminary results. Please do not quote. Insured and Uninsured Children Age 0-18 by FPL: CPS 1996-2002

9 26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by Eligibility for Free Medical Assistance: CPS 1996-2002

10 26 September 2003Preliminary results. Please do not quote. Uninsured Children Age 0-18 by FPL: CPS 1996-2002, HHS 2001

11 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 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. 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

12 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 00046-01. Sub-Contract Research Corporation of the University of Hawaii, Project No. 659075. 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.

13 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

14 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.

15 26 September 2003Preliminary results. Please do not quote. Hawaii SCHIP Program Eligibility by Age and Federal Poverty Level

16 26 September 2003Preliminary results. Please do not quote. Hawaii SCHIP Enrollment FFY 2001: 7,137 FFY 2002: 8,474 http://www.cms.gov/schip/schip02.pdf

17 26 September 2003Preliminary results. Please do not quote. SCHIP FMAP Federal Medical Assistance Percentage (FMAP) FFY 2002 69.44% FFY 2003 71.14%

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

19 26 September 2003Preliminary results. Please do not quote. Insurance Coverage Rates by FPL: Children Age 0-18, HHS 2001. 45,830 92.90% 1529 3.10% 1976 4.01% 25,334 23.09% 78,929 71.92% 5,478 4.99%

20 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 2001 51,144 based on pooled HHS 2000-2001 57,121 based on pooled CPS 1996-2002 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?

21 26 September 2003Preliminary results. Please do not quote. Incurred Per Capita Expenses 2001: Uninsured Children Age 0-18, 200-300% FPL Emergency Room & Hospital Inpatient Discharge $188 Hospital Operated Clinics? Private Physician Offices? Primary Care Facilities? Pharmaceuticals, etc.? TOTAL$188

22 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 200-300% of FPL? $188

23 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

24 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, 2000 2001, 2002 HHS: Post-Expansion The HHS is Quasi-Experimental Data Treatment Group: Age 0, 185-200%; Age 1-5, 133-200%; Age 6-18, 100-200% FPL. Control Group: Age 0-18,200-250% FPL.

25 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 2000-5000 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

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