Our paper represents the first published paper conducting a serious examination of the effect of the State Children’s Health Insurance Program (SCHIP) on public health insurance take-up (enrollment), crowd-out (substitution of public coverage for private coverage), and the overall effect on uninsurance for children.

“The political battle to re-authorize SCHIP this year has placed research such as ours squarely in the policy spotlight.”

The research is also noteworthy because we are the first to evaluate the impact of so-called "anti-crowd-out" provisions of the law, the most popular being waiting periods between prior insurance coverage and eligibility for SCHIP. It also probably did not hurt that the article received the 2005 Article-of-the-Year Award from AcademyHealth, the premier health services research and policy organization.

  Does it describe a new discovery, methodology, or synthesis of knowledge?

While the econometric approach we take is consistent with prior literature, we did discover the possibility that respondents to the Current Population Survey (CPS)—a monthly survey of about 50,000 households conducted by the Bureau of the Census for the Bureau of Labor Statistics—our primary data source, are misinterpreting the question about privately purchased health insurance and potentially mistaking their public insurance for private (non-employer or union-related insurance). We adjusted our results to account for this possible misinterpretation in the data.

  Would you summarize the significance of your paper in layman’s terms?

In brief, we find that take-up of the SCHIP expansions to be low: if you make 100 children eligible, about nine children will enroll in public insurance. Moreover, crowd-out of public coverage is relatively high: of those nine children who enroll, four or five would have had private insurance in the absence of the expansions.

  How did you become involved in this research and were any particular problems encountered along the way?

The research was initiated not long after Lo Sasso received a K02 Independent Scientist Award from the Agency for Healthcare Research and Quality to examine employer-sponsored health insurance. Buchmueller has an extensive history of research focused on private health insurance issues. Our collaboration on this research was a natural one. There were no particular problems encountered during the project, though cataloging the state eligibility criteria and rules was certainly a time-consuming task.

  Where do you see your research leading in the future?

Since the publication of our research, we have expanded the analysis is several directions. We have jointly pursued follow-up research, examining how immigrant populations were affected by SCHIP. Lo Sasso is pursuing a line of research to examine how public health insurance expansions compare to direct funding for front-line "safety net" providers such as community health centers and public hospitals in terms of children’s health and well being. Put differently, this ongoing research aims to determine where the marginal public dollar is best spent, on coverage expansions or support for safety net providers.

  Are there any social or political implications for your research?

The political battle to re-authorize SCHIP this year has placed research such as ours squarely in the policy spotlight. Our paper, for example, figured prominently in a Congressional Budget Office report in 2007 synthesizing findings related to SCHIP and crowd-out.

The issue of crowd-out is particularly relevant because, first, its presence suggests that the target group of children may not necessarily need public coverage or benefit from it to the extent argued by politicians and, second, it has repercussions for expenditures associated with SCHIP, as more children may enroll than were anticipated prior to implementation of the policy.