The Long-Term Impact of the State Children's Health Insurance Program on Health and Educational Outcomes

The State Children’s Health Insurance Program (SCHIP) provides health insurance to poor children, and in some cases parents, who do not meet the income and categorical eligibility requirements imposed by the Medicaid program. Although past research has found that children enrolled in SCHIP have fewer unmet health needs than uninsured children, other research suggests that a substantial number of children who were enrolled in the SCHIP program would have had private health insurance coverage. Because of the heterogeneity of private insurance coverage among the low income population, SCHIP has been shown to reduce disparities in coverage in the short run. However, there are very few studies on the long term impact of SCHIP relative to private insurance and the uninsured on outcomes. Using the kindergarten through eighth grade waves of the Early Childhood Longitudinal Study, Kindergarten Class of 1998-1999 (ECLS-K), which spans the period from 1999 to 2007, we investigate the long term impact of SCHIP coverage on health and educational outcomes. The ECLS-K is a nationally representative survey of children entering kindergarten and contains information collected from parents, teachers, and school administrators. We limit the sample to children living in families with the household income between 100% – 400% of the federal poverty line, and merge in information on state-level SCHIP eligibility requirements in each year. In order to model the long term effects of public coverage, we construct a variable measuring duration (in months) in public coverage, private coverage, and without any health insurance in first grade through eighth grade. We then estimate the impact of duration in SCHIP coverage on health and educational outcomes in the eighth grade. We account for selection into SCHIP using simulated eligibility as an instrumental variable. The instrument is constructed by creating a fixed national sample from the spring kindergarten wave, and then simulating the proportion of children of that sample who would be eligible for SCHIP of the given household income, family size, age, race, state of residence, and year. Our estimates indicate that the children covered by SCHIP have higher rates of being diagnosed with asthma and diabetes and receiving treatment for them in the eighth grade than the privately insured children. However, children enrolled in SCHIP have lower utilization of dental care than the privately insured. Our results will be useful to policy makers who seek to close the long-term gaps in access to care between publicly and privately insured children.