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Hawai `i ’s Uninsured Population: Children Age 0-18

Hawai `i ’s Uninsured Population: Children Age 0-18. Gerard Russo Sang-Hyop Lee Lawrence Nitz University of Hawai `i at M ānoa Hawai`i Coverage for All Project IV Technical Workshop 26 September 2003. Data Sources. Current Population Survey March Demographic Supplement 1996-2002

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Hawai `i ’s Uninsured Population: Children Age 0-18

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  1. 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 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.

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 Please do not quote.

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 Please do not quote.

  4. Uninsured Children Age 0-18 with 95% Confidence Interval: Hawaii Health Survey 2000, 2001; Current Population Survey 1996-2002 Preliminary results. Please do not quote.

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 Please do not quote.

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 Please do not quote.

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 Please do not quote.

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 Please do not quote.

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 Please do not quote.

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 Please do not quote.

  11. 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 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.

  12. 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. 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.

  13. 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 Preliminary results. Please do not quote.

  14. 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. Preliminary results. Please do not quote.

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 Please do not quote.

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

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

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

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

  20. 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? Preliminary results. Please do not quote.

  21. Incurred Per Capita Expenses 2001: Uninsured Children Age 0-18, 200-300% FPL Preliminary results. Please do not quote.

  22. 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 Preliminary results. Please do not quote.

  23. 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 Preliminary results. Please do not quote.

  24. 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. Preliminary results. Please do not quote.

  25. 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 Preliminary results. Please do not quote.

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