Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Proponents herald the flexibility that comes with devolution. They maintain that the transfer of program authority enables local officials to craft policy solutions more aligned with constituent needs. Critics counter that devolution fosters incentives to limit public services resulting in declining services to the poor, known as the “race to the bottom.” While many studies have sought to assess the State Children’s Health Insurance Program (SCHIP), few have analyzed its devolutionary policy aspects and consequences for recipients. A number of states received criticism because spending on SCHIP has fallen well short of federal allotments. Between FY 99 and 05, 36 states spent far less on SCHIP than the federal monies appropriated, leaving some $7 billion unused. Because of the unspent balances, Congress began redistributing some of the unspent funding to states that exhausted their federal allotment. States that tended to have the highest rates of uninsured children used a fraction of their federally allotted funds. For example, Texas spent only $1.8 billion of the $3.5 billion (54%) of their available federal funding while having one of the highest rates of uninsured children (19.9%) in the country. Rhode Island spent 100% of its $71.7 million in federally allocated funds and accessed an additional $114 million in redistributed funding to expand coverage for children and adults. Rhode Island has one of the lowest rates of uninsured children (6.1%) in the country. Also, relationships exist between the use of federally allotted funding and SCHIP benefits. Despite the clear benefit of expanding coverage to children, the devolutionary effects of SCHIP have several weaknesses in regard to national health care strategy. Supporters of devolution can find a number of reasons to take solace in the fact that several states have gone beyond federally mandated minimums to offer programs and services to a greater number of residents. Detractors of devolution will find continued pause in states’ ability to manage policy on large scale issues and the disappointment in the unfulfilled promise of SCHIP. Despite mixed evidence, states are playing an increasingly larger role in health policy innovation in the absence of federal leadership. Access to health care for those most in need may depend on the individual’s state of residence.

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: Historically, access to health care in the United States has been viewed in terms of one?s ability to pay for needed medical services or the actual availability of those services. Until fairly recently, transportation access was not seen as a major

Publication Type: Conference Paper/Unpublished Manuscript
Abstract: A textual analysis of the coverage of the debate surrounding the expansion of the State Children’s Health Insurance Program (SCHIP) uses Pan and Kosicki’s conceptual framework of news texts and finds five primary frames in the news stories that appear in the four newspapers that are the focus of this study. Those frames are emotional appeal, political rhetoric, political strategy, SCHIP as a symbol of a broader debate, and working together/bipartisanship. The stories examined contained multiple frames, and there was clear evidence of a shift in the frames used over the time period covered in this study. The analysis also showed some differences in how the newspapers covered the issue. Collectively, the four newspapers succeeded in making it clear to their readers that there is a deep philosophical divide over what the role of the federal government should be in ensuring access to health care and in providing them with a taste of the tenor of the debate. However, instead of using the SCHIP debate as a means to begin educating readers about the larger health care crisis in the country, the four newspapers stuck to the traditional journalism of the present, focusing on individual episodic developments rather than the broader theme of health care access.

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: The social magic of redefining children potentially both expands prenatal care and jeopardizes women’s health care options and rights. This paper explores the material and cultural consequences of those six states who have adopted the States Children’s Insurance Program (SCHIP) rule change to revise the definition of “child” to include the period of time from conception to age 19. Our analysis suggests that no expansion of benefits to new populations has occurred; rather adoption of the rule change allows these states to use primarily federal rather than state funds to cover existing populations. However, institutionalized identities of pre-persons have been established. What will occur as groups begin to reorient their actions based on this certified interpretive strategy? What are the potential repercussions of this now institutionalized cultural logic of when personhood begins?

Publication Type: Abstract
Abstract: Rationale: Lack of dental insurance is one of the main barriers to access to dental care for many low-income children in the U.S. The State Children’s Health Insurance Program (SCHIP), created by Congress in 1997, expands eligibility for public dental insurance to uninsured low-income children in almost all states. SCHIP may have extensive influence because it is also designed to facilitate Medicaid enrollment and it gives states flexibility in experimenting with new models that may overcome historical obstacles to access to dental care in public programs. Yet the extent to which SCHIP has improved children’s access to and use of dental services is largely unknown, especially at the national level.

Objective: To provide national estimates of the total implementation effects of SCHIP on dental care access and use for low-income children.

Methodology: Two separate analyses are conducted to estimate (1) the effect of program availability on dental care access and use for low-income children (regardless of eligibility or enrollment); and (2) more specifically, changes in dental care access and use for children who gained public insurance as a result of SCHIP implementation. In the first analysis, we consider SCHIP implementation a natural experiment, which has considerable variation in the timing of program implementation across states. We use the variation to identify the effect of SCHIP availability on dental care access (unmet need for dental care due to cost in the past year) and dental services use (time since last dental visit) for any low-income (<300% Federal Poverty Level) child in county and time fixed effects models. In the second analysis, we employ the instrumental variables method to “identify” children who had public insurance due to SCHIP implementation in addition to deal with endogeneity of insurance. State-level SCHIP program features are selected as instruments for public coverage, including program availability, eligibility thresholds, and waiting periods. By focusing on SCHIP’s overall effects, both analyses avoid the difficulty of imputing program eligibility or misreporting of SCHIP enrollment in the data. Both analyses estimate linear probability models adjusted for survey designs. The data source is the National Health Interview Survey 1997-2002 (N = 40,000+).

Results: SCHIP availability for more than one year reduced the likelihood of experiencing unmet dental care need for any low-income child by 2.8 percentage point; increased the probability of having a dental visit within 6 months or in the past 6-12 months by 2.2 and 0.9 percentage point, respectively. Compared with their uninsured counterparts, those who obtained public coverage from SCHIP implementation were less likely to report unmet need for dental care by 11.6 percentage point, and more likely to have visited a dentist within 6 months or in the past 6-12 months by 31 and 35.7 percentage point, respectively. School-aged children (6-17 years) fared better than younger children. Type of SCHIP program had no differential effects.

Conclusions: Consistent results from two analytical approaches provide solid evidence that SCHIP implementation has significantly reduced financial barriers to dental care and increased use of dental services for low-income children in the U.S.