Three Essays on the State Children's Health Insurance Program Público

Abstract

This dissertation studies the impact of public health insurance expansions under the 1997 State Children's Health Insurance Program (SCHIP) on different health outcomes. The first chapter estimates the impact of the SCHIP expansion on vaccination status among children under age 2 in a timely manner. I employ a simulated instrumental variables strategy to address the issue of selection into public health insurance programs. I find that being eligible for public health insurance is associated with a higher probability that a child receives recommended vaccine series without lengthy delays. In contrast, I find little effect for the single-dose vaccines such as varicella and MMR. In light of the positive health consequences associated with vaccinations, these results imply that expanding health insurance coverage could improve social welfare and the welfare of children with low socioeconomic status. The second chapter investigates the impact of health insurance expansions under SCHIP on birth outcomes among teenage mothers. I employ ordered probit and quantile regression to evaluate the existence of heterogeneous eligibility effects on birth outcomes of teenage mothers. Results show that increased public insurance income eligibility is associated with significant improvements in prenatal care utilization among teenage mothers. For teenage mothers with singleton births, the expanded insurance eligibility is associated with a small but significant increase in birth weight. I also find that pregnancies with lower health endowments may benefit more from the expanded eligibilities than pregnancies with great endowments. The third paper is co-authored with David Frisvold. In this paper, we examine the impact of SCHIP/Medicaid eligibility expansions for children on the prevalence of food insecurity among families with children. Our results suggest that being eligible for SCHIP/Medicaid reduces the probability that a family with children has low food security. We also find that SCHIP/Medicaid eligibility has stronger effects on families in states that had higher uninsured rates among children before SCHIP expansion and low income families with income less than 185 percent of the Federal Poverty Level.

Table of Contents

Table of Contents

Contents

Page

Chapter 1: The U.S. Infant Immunization Coverage in the Post-SCHIP Era: An Instrumental Variables Approach

1

1.1.

Introduction

2

1.2.

Background

4

1.2.1.

SCHIP

4

1.2.2.

Childhood Vaccine

8

1.3.

Literature review

12

1.4.

Identification Strategy

15

1.5.

Data

18

1.6.

Results

25

1.7.

Robustness Checks

28

1.8.

Conclusion

31

References

33

Chapter 2: The State Children's Health Insurance Program (SCHIP) and Birth Outcomes of Teenage Mothers

51

2.1.

Introduction

52

2.2.

Background

53

2.2.1.

Teenage Pregnancy

53

2.2.2.

SCHIP

55

2.2.3.

Links between Eligibility Expansions and Birth Outcomes

58

2.3.

Literature Review

59

2.4.

Data

62

2.5.

Health Outcomes

64

2.6.

Identification Strategy

65

2.7.

Results

69

2.7.1.

Analysis of Prenatal Visits

69

2.7.2.

Analysis of Birth Outcomes among Singletons

70

2.7.3.

Analysis of Birth Outcomes among Twins

70

2.8.

Robustness Checks

71

2.9.

Conclusion

73

References

75

Chapter 3: The Impact of SCHIP Expansions on Food Insecurity among Low-Income Families with Children

93

3.1.

Introduction

94

3.2.

Background

96

3.3.

Literature Review

98

3.4.

Identification Strategy

100

3.5.

Data

102

3.6.

Results

106

3.7.

Conclusion

109

References

110

Table of Contents: List of Tables

Contents

Page

Table 1.1.

Summary of SCHIP Expansions by State and Time

38

Table 1.2.

Recommended Childhood Vaccine Schedule, January-June 1996

40

Table 1.3.

Fraction of Eligible Children under Age 2 in the SIPP

41

Table 1.4.

Summary Statistics

42

Table 1.5.

Summary Statistics for Outcome Variables

43

Table 1.6.

SCHIP/Medicaid Eligibility and UTD Vaccination Rate without Lengthy Delay (Linear Probability Models)

44

Table 1.7.

SCHIP/Medicaid Eligibility and Site of Delivery (Linear Probability Models)

46

Table 1.8.

IV Estimates for the Whole Sample with Different Sizes of Simulations

47

Table 1.9.

Subgroup Analysis Using IV

48

Table 1.10.

Marginal Effects of SCHIP/Medicaid Eligibility on the Probability of Being UTB for Childhood Vaccines without Lengthy Delays

49

Table 1.11.

Lower Bounds and Upper Bounds of the Impact of SCHIP Expansions on the Probability of Being UTD for Childhood Vaccines without Lengthy Delays

50

Table 2.1.

Summary of SCHIP expansions by State and Time

78

Table 2.2.

Summary Statistics

80

Table 2.3.

Fraction of Female Teenage Eligible for Public Insurance in the SIPP

81

Table 2.4.

Summary Statistics for Outcome Variables

82

Table 2.5.

SCHIP/Medicaid Income Eligibility by State over Time for Teenagers

83

Table 2.6.

Effects of SCHIP/Medicaid Expansions on the Number of Prenatal Care Visits

85

Table 2.7.

Effects of SCHIP/Medicaid Expansions on Singleton Births

87

Table 2.8.

Effects of SCHIP/Medicaid Expansions on Twin Births

88

Table 2.9.

Ordered Probit Estimation of the Impact of Eligibility Expansions on Birth Weight

89

Table 2.10.

Quantile Regression Results of the Impact of Eligibility Expansions on Birth Weight

90

Table 2.11.

Sensitivity Analysis of the Effects of Eligibility Expansions on Singleton Births

91

Table 3.1.

Summary of SCHIP expansions by State and Time

112

Table 3.2.

Fraction of Children under Age 18 Eligible for SCHIP/Medicaid in the SIPP

114

Table 3.3.

Summary Statistics

115

Table 3.4.

Summary Statistics for Outcome Variables

117

Table 3.5.

SCHIP/Medicaid Eligibility and Family Food Insecurity Status

118

Table 3.6.

Subgroup Analysis Using IV

118

Appendix 3.A.

Food Insecurity Measures in the United States

119

Appendix 3.B.

Complete Results for OLS and IV Estimation on the Impact of SCHIP/Medicaid Eligibility on Food Security

121

Table of Contents: List of Figures

Contents

Page

Figure 1.1.

SCHIP Enrollment 1998-2009

37

Figure 2.1.

SCHIP/Medicaid Income Eligibility 1996-2002

92

Figure 2.2.

Low Birth Weight Babies Born to Teenage Mothers, 1995-2002

92

About this Dissertation

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School	Laney Graduate School
Department	Economics
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Economics, Labor Economics, General
Palabra Clave	SCHIP Medicaid Health Insurance
Committee Chair / Thesis Advisor	Markowitz, Sara, Emory University
Committee Members	Jacho-Chavez, David, Emory University Frisvold, David, Emory University Mialon, Sue, Emory University

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