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The State Children’s Health Insurance Program (SCHIP) and Health Insurance Coverage in Hawai ` i. Gerard Russo, Ph.D. Sang-Hyop Lee, Ph.D. Lawrence Nitz, Ph.D. Thamana Lekprichakul, Ph.D. Rui Wang, Ph.D. Candidate Jaclyn Lindo, Ph.D. Student University of Hawai `i at M ānoa

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The State Children’s Health Insurance Program (SCHIP) and Health Insurance Coverage in Hawai ` i


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    1. The State Children’s Health Insurance Program (SCHIP) and Health Insurance Coverage in Hawai`i Gerard Russo, Ph.D. Sang-Hyop Lee, Ph.D. Lawrence Nitz, Ph.D. Thamana Lekprichakul, Ph.D. Rui Wang, Ph.D. Candidate Jaclyn Lindo, Ph.D. Student University of Hawai`i at Mānoa Kathleen Baker, Ph.D., Hawaii Department of Health HRSA SPG Technical Workshop VIII 30 January 2006 This research is funded in part through a U.S. Health Resources and Services Administration, State Planning Grant to the Hawaii State Department of Health. Sub-Contract Research Corporation of the University of Hawaii. Research conducted by the University of Hawaii, Social Science Research Institute in collaboration with the Hawaii State Department of Health, Hawaii Institute for Public Affairs: Hawaii Uninsured Project and the Hawaii Health Information Corporation.

    2. Economic Issues in SCHIP • Further Expansion will Capture Middle Class Children. • 200% FPL (current): $46,000 family of four. • 250% FPL (proposed): $57,500 family of four. • 300% FPL (possible): $69,000 family of four. • Few Children Between 200% and 300% FPL are Uninsured. • In some cases Public Insurance will replace Private Insurance. • Low-End Estimates 5-10% Crowd-Out • High-End Estimates 50-70% Crowd-Out • We don’t know. Preliminary results. Revised January 2006. Subject to further revision.

    3. Economic Issues (continued)Crowd-Outs Effects • Families Gain Free Children’s Coverage • Partially offset by higher taxable wages. • Employers Gain from reduced Family Plan Participation. • Partially offset by higher taxable wages. • Partially offset by reduced productivity or higher wages. • Federal Taxpayers Lose (70% FMAP) • Partially offset by higher wage and income tax receipts. • State Taxpayers Lose (30% of expenditures) • Partially offset by higher income tax receipts. • Excess Burden of Increased Taxation (0-50%) • National Economy (70%) • State Economy (30%) • Health Plans (neutral or negative effect) • Health Care Providers (neutral or negative effect) • Net Gain or Loss to Society as a Whole? National or State? Preliminary results. Revised January 2006. Subject to further revision.

    4. Social Security Amendments: Public Health Insurance USA • Medicare: Title XVIII of the Social Security Act 1965 • Federal Program • Age 65+, Disabled, ESRD • Medicaid: Title XIX of the Social Security Act 1965 • State/Federal Program • Poor, Blind, Disabled, Medically Indigent • SCHIP: Title XXI of the Social Security Act 1997 • Low-Income Uninsured Children Age 0-18 Preliminary results. Revised January 2006. Subject to further revision.

    5. Hawai`i Title XXI Program: SCHIP • July 2000 SCHIP Hawaii children aged 0 to 18 years 200% of the FPL effective. • Hawaii SCHIP is implemented as a Medicaid/QUEST expansion. • The Hawaii Medicaid Program is implemented as a Managed Care & Managed Competition Program under the acronym QUEST: 1115 Waiver Demonstration. Preliminary results. Revised January 2006. Subject to further revision.

    6. SCHIP Federal Medical Assistance Percentage: Hawaii 2000-2005 Preliminary results. Revised January 2006. Subject to further revision.

    7. Hawai`i SCHIP Program Eligibility by Age and Federal Poverty Level Preliminary results. Revised January 2006. Subject to further revision.

    8. Preliminary results. Revised January 2006. Subject to further revision.

    9. Hawai`i Population: Children Age 0-18 by Eligibility, 2002-2004(3-Year Average) Preliminary results. Revised January 2006. Subject to further revision.

    10. Comparison of CPS, HHS and SLAITS (age 0-17) Note: SLAITS and HHS Estimates Based on UHM Imputation for Missing Data Preliminary results. Revised January 2006. Subject to further revision.

    11. CPS 2001-2005: All Children Preliminary results. Revised January 2006. Subject to further revision.

    12. HHS 2000-2004: All Children Preliminary results. Revised January 2006. Subject to further revision.

    13. CPS 2001-2005: Uninsured Children Preliminary results. Revised January 2006. Subject to further revision.

    14. HHS 2000-2004: Uninsured Children Preliminary results. Revised January 2006. Subject to further revision.

    15. CPS 2001-2005: Percent Uninsured Preliminary results. Revised January 2006. Subject to further revision.

    16. HHS 2000-2004: Percent Uninsured Preliminary results. Revised January 2006. Subject to further revision.

    17. Mahalo! This research is funded in part by U.S. Department of Health and Human Services Health Resources & Services Administration State Planning Grant Hawaii State Department of Health. Preliminary results. Revised January 2006. Subject to further revision.