What other programs can teach us: increasing participation in health insurance programs

Dahlia K Remler, Sherry A Glied, Dahlia K Remler, Sherry A Glied

Abstract

Many uninsured Americans are already eligible for free or low-cost public coverage through Medicaid or Children's Health Insurance Program (CHIP) but do not "take up" that coverage. However, several other public programs, such as food stamps and unemployment insurance, also have less-than-complete take-up rates, and take-up rates vary considerably among programs. This article examines the take-up literature across a variety of programs to learn what effects nonfinancial features, such as administrative complexity, have on take-up. We find that making benefit receipt automatic is the most effective means of ensuring high take-up, while there is little evidence that stigma is important.

References

    1. Selden T, Banthin J, Cohen J. Medicaid’s problem children: eligible but not enrolled. Health Aff. 1998;17(3):192–200.
    1. Perry MJ, Stark E, Valdez RB. Barriers to Medi-Cal Enrollment and Ideas for Improving Enrollment: Findings From Eight Focus Groups in California With Parents of Potentially Eligible Children. Menlo Park, Calif: Kaiser Family Foundation; September1998. Report 1436.
    1. Low Income Medicare Beneficiaries: Further Outreach and Administrative Simplification Could Increase Enrollment. Washington, DC: General Accounting Office; April1999. GAO Report HEHS-99–61.
    1. Long SH, Marquis MS. Gaps in employer coverage: lack of supply or lack of demand? Health Aff. 1993;12(suppl):282–294.
    1. Thorpe K, Florence C. Why are workers uninsured? Employer-sponsored health insurance in 1997. Health Aff. 1999;18(2):213–218.
    1. Cooper P, Schone BS. More offers, fewer takers for employment-based health insurance: 1987 and 1996. Health Aff. 1997;16(6):142–149.
    1. Scholz JK. The earned income tax credit: participation, compliance and antipoverty effectiveness. Natl Tax J. 1994;47(1):63–85.
    1. Castner L, Cody S. Trends in Food Stamp Participation Rates: Focus on 1997. Alexandria, Va: US Dept of Agriculture, Food and Nutrition Service; 1999.
    1. Blank R, Ruggles P. When do women use Aid to Families With Dependent Children and food stamps? The dynamics of eligibility vs participation. J Hum Resources. 1996;31:57–89.
    1. Blank RM, Card DE. Recent trends in insured and uninsured unemployment: is there an explanation? Q J Economics. 1991;106:1157–1189.
    1. Storer P, Van Audenrode MA. Unemployment insurance take-up rates in Canada: facts, determinants and implications. Can J Economics. 1995;28;822–835.
    1. Koning RH, Ridder G. Rent assistance and housing demand. J Public Economics. 1997;66:1–31.
    1. Warlick JL. Participation of the aged in SSI. J Hum Resources. 1982;17:236–260.
    1. McGarry K. Factors determining participation of the elderly in supplemental security income. J Hum Resources. 1996;31:331–359.
    1. Currie J, Gruber J. Health insurance eligibility, utilization of medical care and child health. Q J Economics. 1996;111:431–466.
    1. Moffitt R. Historical growth in participation in Aid to Families With Dependent Children: was there a structural shift? J Post Keynesian Economics. 1987;9:347.
    1. Craig P. Costs and benefits: a review of research on take-up of income-related benefits. J Soc Policy. 1991;20:537–565.
    1. Dion RM, Pavetti L. Access to and Participation in Medicaid and the Food Stamp Program: A Review of the Recent Literature. Washington, DC: Mathematica Policy Research Inc; 2000.
    1. Horan PM, Austin PL. The social bases of welfare stigma. Soc Problems. 1997;648–657.
    1. Rainwater L. Stigma in income-tested programs. In: Garfinkel I, ed. Income-Tested Transfer Programs: The Case for and Against. New York, NY: Academic Press; 1982.
    1. Moffitt R. An economic model of welfare stigma. Am Econ Rev. 1983;73:1023–1035.
    1. Besley T, Coate S. Understanding welfare stigma: taxpayer resentment and statistical discrimination. J Public Economics. 1992;48:165–183.
    1. Yaniv G. Welfare fraud and welfare stigma. J Econ Psychol. 1997;18:435–451.
    1. Daponte BO, Sanders S, Taylor L. Why do low-income households not use food stamps? Evidence from an experiment. J Hum Resources. 1998;34:612–628.
    1. Madrian BC, Shea DF. The Power of Suggestion: Inertia in 401(k) Participation and Savings Behavior. Cambridge, Mass: National Bureau of Economic Research; 2000. Working Paper 7682.
    1. Anderson PM, Meyer BD. Unemployment insurance and the after-tax value of benefits. Q J Economics. 1997;112:913–937.
    1. Garrett B, Glied S. Does state AFDC generosity affect child SSI participation? J Policy Analysis Manage. 2000;19:275–295.
    1. Yelowitz AS. Public policy and health insurance choices of the elderly: evidence from the Medicare buy-in program. J Public Economics. 2000;78:301–324.
    1. Blundell R, Fry V, Walker I. Modelling the take-up of means-tested benefits: the case of housing benefits in the United Kingdom. Econ J. 1988;98(suppl 390):58–74.
    1. Diehr P, Madden C, Cheadle A, Martin DP, Patrick DL, Skillman S. Will uninsured people volunteer for voluntary health insurance? Experience from Washington State. Am J Public Health. 1996;86:529–532.
    1. Stuber JP, Maloy KA, Rosenbaum S, Jones KC. Beyond Stigma: What Barriers Actually Affect the Decisions of Low-Income Families to Enroll in Medicaid? Washington, DC: Center for Health Services Research and Policy, George Washington University; July2000.
    1. Ettner SL. Medicaid participation among the eligible elderly. J Policy Analysis Manage. 1997;16:237–255.
    1. Duclos J. Modeling the take-up of state support. J Public Economics. 1995;58:391–415.
    1. Norton EC. Elderly assets, Medicaid policy and spend-down in nursing homes. Rev Income Wealth. 1995;41:309–329.
    1. Huby M, Whyley C. Take-up and the social fund. J Soc Policy. 1996;25:1–18.
    1. Neumann PJ, Bernardin MD, Evans WN, Bayer EJ. Participation in the qualified Medicare beneficiary program. Health Care Financing Rev. 1995;17:169–178.
    1. Zedlewski S, Brauner S. Declines in Food Stamp and Welfare Participation: Is There a Connection? Washington, DC: The Urban Institute; 1999. Working Paper 99–13.
    1. Ku L, Garrett B. How Welfare Reform and Economic Factors Affected Medicaid Participation: 1984–96. Washington, DC: The Urban Institute; 2000. Working Paper 00–01.
    1. Ellwood M, Irvin C. Welfare Leavers and Medicaid Dynamics: Five States in 1995. Cambridge, Mass: Mathematica Policy Research Inc; 2000.
    1. Blank, R. The effect of medical need and Medicaid on AFDC participation. J Hum Resources. 1989;24:54–87.
    1. Moffitt R, Wolfe B. The effect of the Medicaid program on welfare participation and labor supply. Rev Economics Statistics. 1992;74:615–626.
    1. Yelowitz AS. Using the Medicare buy-in program to estimate the effect of Medicaid on SSI participation. Econ Inquiry. 2000;38:419–441.
    1. Zedlewski SR, Gruber A. Former Welfare Families Continue to Leave the Food Stamp Program. Washington, DC: The Urban Institute; 2001. Working Paper 01–05.
    1. Kenney G, Haley J. Why Aren’t More Uninsured Children Enrolled in Medicaid or SCHIP? Washington DC: The Urban Institute; May2001. Assessing the New Federalism Policy Brief B-35.
    1. Hu W. Elderly immigrants on welfare. J Hum Resources. 1998;33:711–741.

Source: PubMed

3
Abonnieren