The Role of Public and Private Insurance Expansions and Premiums for Low-income Parents Lessons From State Experiences

Background: Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. Objectives: To assess the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Design: Cross-sectional analysis of the 2000-2013 March supplements to the Current Population Survey, with data from the Medical Expenditure Panel Survey-Insurance Component and the Area Resource File. Methods: Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-indifference modeling. All analyses controlled for household, parent, child, and local area characteristics that could affect insurance status. Results: Expansions increased parental coverage by 2.5 percentage points, and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents' insurance. Conclusions: Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.