As part of the 2009 reauthorization of the Children's Health Insurance Program (CHIP), states were provided with new resources and options to help reduce uninsurance rates among children. These included: expanded eligibility guidelines; simplified enrollment and renewal procedures; and funding for outreach campaigns. Fifteen states chose to raise their CHIP income eligibility thresholds. In one of the first studies to analyze the impact of these recent CHIP expansions on the program's enrollment, the authors found that "expansion states" saw a 1.1-percentage-point reduction in uninsurance among newly eligible children, cutting this group's uninsurance rate by nearly 15 percent. The study, being released today as a Web First by Health Affairs, also discovered that public coverage increased by 2.9 percentage points, revealing a shift among some of these families away from private insurance, and found variable effects across states.
The authors used study data taken from the 2008-12 American Community Survey (ACS) and compared changes in health insurance coverage for children who became newly eligible for CHIP with changes for those with slightly higher incomes who were not eligible for CHIP. They focused on the fifteen "expansion states" before and after the program's expansion. Since the state expansions occurred at different times between 2009 and 2012, the timelines for states varied. "Our findings suggest that CHIP provides coverage to even higher-income children who, without the program, might otherwise not have access to affordable coverage and would be at increased risk of being uninsured," conclude the authors. "Projections of children's coverage under the ACA have found that as many as 1.8-2.4 million children could lose coverage if CHIP funding is not continued. In this light, CHIP appears to serve as a backstop for many families, covering children who do not qualify for Medicaid yet do not have access to affordable private insurance through employers or a health insurance Marketplace."