Academic journal article Inquiry

What Fraction of Medicaid Enrollees Have Private Insurance Coverage at the Time of Enrollment? Estimates from Administrative Data

Academic journal article Inquiry

What Fraction of Medicaid Enrollees Have Private Insurance Coverage at the Time of Enrollment? Estimates from Administrative Data

Article excerpt

Abstract

We use administrative data from Wisconsin to determine the fraction of new Medicaid enrollees who have private health insurance at the time of enrollment in the program. Through the linkage of several administrative data sources not previously used for research, we are able to observe coverage status directly for a large fraction of enrollees and indirectly for the remainder. We provide strict bounds for the percentages in each status and find that the percentage of new enrollees with private insurance coverage at the time of enrollment lies between 16 percent and 29 percent, and the percentage that dropped private coverage in favor of public insurance lies between 4 percent and 18 percent. Our point estimates indicate that, among all new enrollees, 21 percent had private health insurance at the time of enrollment and that 10 percent dropped this coverage. Our results show substantially lower rates than previous studies of crowd-out following public health insurance expansions and significant rates of dual coverage, whereby new enrollees into public insurance retain their previously held private insurance coverage.

Keywords

crowd-out, Medicaid, SCHIP

Introduction

In this study, we determine the fraction of new Medicaid enrollees who have private health insurance at the time of enrollment in the program and, of those, the fraction that dropped their private coverage. This study is, to our knowledge, the first to use administrative data to estimate the movement between private and public insurance programs. Our findings also update the understanding of these movements in the context of a private insurance environment that differs substantially from that of a decade ago--in particular, one that today requires higher participant cost-sharing in the form of premiums, deductibles, and co-payments (Kaiser Family Foundation [KFF] 2011). In addition, we identify a subpopulation of new enrollees into public insurance programs that simultaneously held private coverage for at least six months following enrollment, a phenomenon that has received relatively little attention in the literature.

An understanding of the movement between private and public insurance programs is particularly important in today's policy environment. The implementation of the Affordable Care Act (ACA), including Medicaid expansions and premium and cost-sharing subsidies for private, exchange-based health insurance, has heighted concerns about declines in employer-sponsored coverage. As of January 2013, Wisconsin was among eight states with income eligibility thresholds for parents with dependent children already in place that exceed the ACA's 133 percent of the federal poverty level (FPL) threshold for Medicaid eligibility. An additional fifteen states had established other programs for non-disabled childless adults (KFF 2013). As a result, concern about crowd-out goes beyond the migration from employer-sponsored insurance to Medicaid, as these states must decide whether to retain expanded coverage for adults or to reduce eligibility to the 133 percent of FPL threshold, and thereby allow a greater fraction of adults to become eligible for federal subsidies of exchange-based private coverage (State Health Reform Assistance Network 2013).

Understanding the extent to which new enrollees overlap private coverage with public coverage allows for a more nuanced assessment of the prior reported crowd-out rates and may generate policy considerations about the degree to which such dual coverage is desirable.

The linking of various state administrative data sources allow us to accurately capture movements between private and public coverage for individuals who enroll in public coverage, to determine the extent the enrollees into public coverage have and maintain private coverage, and to observe job transitions that may be associated with losses of coverage, none of which have been previously possible. …

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