Effect of Expanding Medicaid for Parents on Children’s Health Insurance Coverage: Lessons From the Oregon Experiment | Pediatrics | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 18.207.129.82. Please contact the publisher to request reinstatement.
1.
Newacheck  PW, Stoddard  JJ, Hughes  DC, Pearl  M.  Health insurance and access to primary care for children.  N Engl J Med. 1998;338(8):513-519.PubMedGoogle ScholarCrossref
2.
Hadley  J.  Insurance coverage, medical care use, and short-term health changes following an unintentional injury or the onset of a chronic condition.  JAMA. 2007;297(10):1073-1084.PubMedGoogle ScholarCrossref
3.
Kaiser Commission on Medicaid and the Uninsured.  The uninsured and the difference health insurance makes.http://kff.org/health-reform/fact-sheet/the-uninsured-and-the-difference-health-insurance/. Accessed August 9, 2013.
4.
Wisk  LE, Witt  WP.  Predictors of delayed or forgone needed health care for families with children.  Pediatrics. 2012;130(6):1027-1037.PubMedGoogle ScholarCrossref
5.
Dubay  L, Guyer  J, Mann  C, Odeh  M.  Medicaid at the ten-year anniversary of SCHIP: looking back and moving forward.  Health Aff (Millwood). 2007;26(2):370-381.PubMedGoogle ScholarCrossref
6.
Kenney  G, Yee  J.  SCHIP at a crossroads: experiences to date and challenges ahead.  Health Aff (Millwood). 2007;26(2):356-369.PubMedGoogle ScholarCrossref
7.
Smith  V, Snyder  L, Rudowitz  R.  CHIP Enrollment: June 2011 Data Snapshot. Washington, DC: Kaiser Family Foundation; 2012.
8.
Kaiser Commission on Medicaid and the Uninsured.  The uninsured: a primer—key facts about health insurance on the eve of coverage expansions.http://kff.org/report-section/the-uninsured-a-primer-2013-2-who-are-the-uninsured/. Accessed January 10, 2014.
9.
DeVoe  JE, Krois  L, Edlund  T, Smith  J, Carlson  NE.  Uninsurance among children whose parents are losing Medicaid coverage: results from a statewide survey of Oregon families.  Health Serv Res. 2008;43(1, pt 2):401-418.PubMedGoogle ScholarCrossref
10.
DeVoe  JE, Krois  L, Edlund  C, Smith  J, Carlson  NE.  Uninsured but eligible children: are their parents insured? recent findings from Oregon.  Med Care. 2008;46(1):3-8.PubMedGoogle ScholarCrossref
11.
DeVoe  JE, Tillotson  CJ, Angier  H, Wallace  LS.  Recent health insurance trends for US families: children gain while parents lose.  Matern Child Health J. 2014;18(4):1007-1016.PubMedGoogle ScholarCrossref
12.
Angier  H, DeVoe  JE, Tillotson  C, Wallace  L, Gold  R.  Trends in health insurance status of US children and their parents, 1998-2008.  Matern Child Health J. 2013;17(9):1550-1558.PubMedGoogle ScholarCrossref
13.
Dubay  L, Kenney  G.  Expanding public health insurance to parents: effects on children’s coverage under Medicaid.  Health Serv Res. 2003;38(5):1283-1301.PubMedGoogle ScholarCrossref
14.
Sommers  BD.  Insuring children or insuring families: do parental and sibling coverage lead to improved retention of children in Medicaid and CHIP?  J Health Econ. 2006;25(6):1154-1169.PubMedGoogle ScholarCrossref
15.
Baicker  K, Finkelstein  A.  The effects of Medicaid coverage: learning from the Oregon experiment.  N Engl J Med. 2011;365(8):683-685.PubMedGoogle ScholarCrossref
16.
Allen  H, Baicker  K, Finkelstein  A, Taubman  S, Wright  BJ; Oregon Health Study Group.  What the Oregon Health Study can tell us about expanding Medicaid.  Health Aff (Millwood). 2010;29(8):1498-1506.PubMedGoogle ScholarCrossref
17.
Finkelstein  A, Taubman  S, Wright  B,  et al; Oregon Health Study Group.  The Oregon Health Insurance Experiment: evidence from the first year.  Q J Econ. 2012;127(3):1057-1106.PubMedGoogle ScholarCrossref
18.
Taubman  SL, Allen  HL, Wright  BJ, Baicker  K, Finkelstein  AN.  Medicaid increases emergency-department use: evidence from Oregon’s Health Insurance Experiment.  Science. 2014;343(6168):263-268.PubMedGoogle ScholarCrossref
19.
Oregon Division of Medical Assistance Programs.  OHP standard reservation list final report, March through October 2008.http://www.oregon.egov.com/oha/healthplan/DataReportsDocs/OHP%20Standard%20Reservation%20List%20Final%20Report.pdf. Accessed May 31, 2013.
20.
Devoe  JE, Gold  R, Spofford  M,  et al.  Developing a network of community health centers with a common electronic health record: description of the Safety Net West Practice-Based Research Network (SNW-PBRN).  J Am Board Fam Med. 2011;24(5):597-604.PubMedGoogle ScholarCrossref
21.
Hatch  B, Angier  H, Marino  M,  et al.  Using electronic health records to conduct children’s health insurance surveillance.  Pediatrics. 2013;132(6):e1584-e1591.PubMedGoogle ScholarCrossref
22.
Angier  H, Gold  R, Crawford  C,  et al.  Linkage methods for connecting children with parents in electronic health record and state public health insurance data.  Matern Child Health J. 2014;18(9):2025-2033.PubMedGoogle ScholarCrossref
23.
Fairbrother  G, Madhavan  G, Goudie  A,  et al.  Reporting on continuity of coverage for children in Medicaid and CHIP: what states can learn from monitoring continuity and duration of coverage.  Acad Pediatr. 2011;11(4):318-325.PubMedGoogle ScholarCrossref
24.
DeVoe  JE, Graham  A, Krois  L, Smith  J, Fairbrother  GL.  “Mind the gap” in children’s health insurance coverage: does the length of a child’s coverage gap matter?  Ambul Pediatr. 2008;8(2):129-134.PubMedGoogle ScholarCrossref
25.
US Department of Agriculture.  Rural-Urban Continuum Codes.http://www.ers.usda.gov/data-products/rural-urban-continuum-codes/.aspx. Accessed August 22, 2013.
26.
US Department of Agriculture.  Supplemental Nutrition Assistance Program (SNAP) data system.http://www.ers.usda.gov/data-products/supplemental-nutrition-assistance-program-(snap)-data-system.aspx. Accessed August 22, 2013.
27.
Hill  HD, Shaefer  HL.  Covered today, sick tomorrow? trends and correlates of children’s health insurance instability.  Med Care Res Rev. 2011;68(5):523-536.PubMedGoogle ScholarCrossref
28.
Cummings  P.  The relative merits of risk ratios and odds ratios.  Arch Pediatr Adolesc Med. 2009;163(5):438-445.PubMedGoogle ScholarCrossref
29.
DeVoe  JE, Ray  M, Graham  A.  Public health insurance in Oregon: underenrollment of eligible children and parental confusion about children’s enrollment status.  Am J Public Health. 2011;101(5):891-898.PubMedGoogle ScholarCrossref
30.
DeVoe  JE, Westfall  N, Crocker  S,  et al.  Why do some eligible families forego public insurance for their children? a qualitative analysis.  Fam Med. 2012;44(1):39-46.PubMedGoogle Scholar
31.
Office of the Legislative Counsel.  Compilation of Patient Protection and Affordable Care Act, 111th Congress, 2nd Sess (2010). http://housedocs.house.gov/energycommerce/ppacacon.pdf. Accessed December 16, 2011.
32.
Kenney  G, Dubay  L, Zuckerman  S, Huntress  M.  Making the Medicaid expansion an ACA option: how many low-income Americans could remain uninsured.http://www.urban.org/publications/412606.html. Accessed May 31, 2013.
33.
Kaiser Family Foundation.  The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid. Washington, DC: Kaiser Family Foundation; 2013.
34.
Rasmussen  PW, Collins  SR, Doty  MM, Garber  T.  In states’ hands: how the decision to expand Medicaid will affect the most financially vulnerable Americans: findings from the Commonwealth Fund Health Insurance Tracking Surveys of US Adults, 2011 and 2012.  Issue Brief (Commonw Fund). 2013;23:1-8.PubMedGoogle Scholar
35.
Sommers  BD, Rosenbaum  S.  Issues in health reform: how changes in eligibility may move millions back and forth between Medicaid and insurance exchanges.  Health Aff (Millwood). 2011;30(2):228-236.PubMedGoogle ScholarCrossref
36.
Short  PF, Graefe  DR, Swartz  K, Uberoi  N.  New estimates of gaps and transitions in health insurance.  Med Care Res Rev. 2012;69(6):721-736.PubMedGoogle ScholarCrossref
37.
Collins  SR, Robertson  R, Garber  T, Doty  MM.  Gaps in health insurance: why so many Americans experience breaks in coverage and how the Affordable Care Act will help: findings from the Commonwealth Fund Health Insurance Tracking Survey of US Adults, 2011.  Issue Brief (Commonw Fund). 2012;9:1-22.PubMedGoogle Scholar
38.
US Census Bureau.  US Census Bureau fact finder.http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml. Accessed July 8, 2014.
39.
Gould  E.  Employer-sponsored health insurance erosion continues in 2008 and is expected to worsen.  Int J Health Serv. 2010;40(4):743-776.PubMedGoogle ScholarCrossref
40.
Fronstin  P.  Sources of health insurance and characteristics of the uninsured: analysis of the March 2012 Current Population Survey.  EBRI Issue Brief. 2012;(376):1-34.PubMedGoogle Scholar
Original Investigation
January 5, 2015

Effect of Expanding Medicaid for Parents on Children’s Health Insurance Coverage: Lessons From the Oregon Experiment

Author Affiliations
  • 1Department of Family Medicine, Oregon Health & Science University, Portland
  • 2OCHIN, Inc, Portland, Oregon
  • 3Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland
  • 4Office of Health Analytics, Oregon Health Authority, Portland
  • 5Kaiser Permanente Center for Health Research, Portland, Oregon
JAMA Pediatr. 2015;169(1):e143145. doi:10.1001/jamapediatrics.2014.3145
Abstract

Importance  In the United States, health insurance is not universal. Observational studies show an association between uninsured parents and children. This association persisted even after expansions in child-only public health insurance. Oregon’s randomized Medicaid expansion for adults, known as the Oregon Experiment, created a rare opportunity to assess causality between parent and child coverage.

Objective  To estimate the effect on a child’s health insurance coverage status when (1) a parent randomly gains access to health insurance and (2) a parent obtains coverage.

Design, Setting, and Participants  Oregon Experiment randomized natural experiment assessing the results of Oregon’s 2008 Medicaid expansion. We used generalized estimating equation models to examine the longitudinal effect of a parent randomly selected to apply for Medicaid on their child’s Medicaid or Children’s Health Insurance Program (CHIP) coverage (intent-to-treat analyses). We used per-protocol analyses to understand the impact on children’s coverage when a parent was randomly selected to apply for and obtained Medicaid. Participants included 14 409 children aged 2 to 18 years whose parents participated in the Oregon Experiment.

Exposures  For intent-to-treat analyses, the date a parent was selected to apply for Medicaid was considered the date the child was exposed to the intervention. In per-protocol analyses, exposure was defined as whether a selected parent obtained Medicaid.

Main Outcomes and Measures  Children’s Medicaid or CHIP coverage, assessed monthly and in 6-month intervals relative to their parent’s selection date.

Results  In the immediate period after selection, children whose parents were selected to apply significantly increased from 3830 (61.4%) to 4152 (66.6%) compared with a nonsignificant change from 5049 (61.8%) to 5044 (61.7%) for children whose parents were not selected to apply. Children whose parents were randomly selected to apply for Medicaid had 18% higher odds of being covered in the first 6 months after parent’s selection compared with children whose parents were not selected (adjusted odds ratio [AOR] = 1.18; 95% CI, 1.10-1.27). The effect remained significant during months 7 to 12 (AOR = 1.11; 95% CI, 1.03-1.19); months 13 to 18 showed a positive but not significant effect (AOR = 1.07; 95% CI, 0.99-1.14). Children whose parents were selected and obtained coverage had more than double the odds of having coverage compared with children whose parents were not selected and did not gain coverage (AOR = 2.37; 95% CI, 2.14-2.64).

Conclusions and Relevance  Children’s odds of having Medicaid or CHIP coverage increased when their parents were randomly selected to apply for Medicaid. Children whose parents were selected and subsequently obtained coverage benefited most. This study demonstrates a causal link between parents’ access to Medicaid coverage and their children’s coverage.

×