Health Policy Center, independent research for better health policy: The Urban Institute

The State Children’s Health Insurance Program (SCHIP) was established in 1997 to provide health insurance coverage for children in families whose incomes were too high to qualify for coverage under Medicaid, but who lacked access to affordable private health insurance coverage. Though an optional program, all states expanded coverage under SCHIP, with an estimated 6.7 million children and 700,000 adults enrolled in SCHIP at some point during 2006. State programs vary in terms of their structure and characteristics (e.g., cost sharing arrangements and income eligibility levels), reflecting the flexibility over program design that was built into the SCHIP statute.

Numerous studies have concluded that SCHIP has been successful in achieving the goals of reducing uninsurance among children and improving their access to care: the number of uninsured children declined following the expansion of SCHIP coverage and both national and numerous state-level studies have found that SCHIP has reduced unmet health needs among children and improved their access to primary care.

As the reauthorization of SCHIP has been debated recently, fundamental questions have arisen about Medicaid and SCHIP coverage for children and families—for example, to whom Medicaid and SCHIP should be targeted, how Medicaid and SCHIP should interface with private coverage, and whether parents should be covered in addition to children.  Urban Institute researchers have contributed to these debates through research conducted under a congressionally-mandated evaluation of SCHIP for the Department of Health and Human Services and independent research conducted for a number of private foundations.  Related Urban Institute research has focused on the impacts of Medicaid reform efforts and the county-based Healthy Kids programs in California that are aimed at filling gaps in coverage for children.  

Urban Institute researchers have used qualitative and quantitative research methods to examine:

• Trends in insurance coverage and public spending for children and adults;
• How public and private premiums affect insurance coverage;
• Impacts of SCHIP expansions on insurance coverage and crowd out, access to care and service use;
• Spillover effects of SCHIP expansions on Medicaid coverage and access to care;
• Implementation issues that have arisen as states expanded their SCHIP programs;
• Strategies states have adopted to minimize crowd out of employer-sponsored coverage and to make use of premium assistance programs;
• Impacts of  public expansions to parents on coverage and access to care;
• How parental health coverage affects children’s coverage and access to care;
• Eligibility for Medicaid and SCHIP and access to affordable private coverage;
• Why some Medicaid and SCHIP-eligible children remain uninsured;
• Access to care for low-income children with public versus private coverage;
• How much preventive care and counseling children are receiving;
• Impacts of enrollment in county-based Healthy Kids programs in California;
• The success of outreach strategies and simplified enrollment procedures.