This update to an earlier report discusses crowd-out and its implications, highlighting findings from recent studies. Crowd-out estimates range from near zero to 60%, depending on the population studied and the methodology used, and are higher-income children. Recent efforts to reduce crowd-out, such as waiting periods and higher premiums, have been shown to discourage enrollment in public programs by both the privately-insured and the uninsured. The brief also discusses the role of the availability and affordability of employer-sponsored insurance in maintaining private coverage.

Prepared for the Centers for Medicare and Medicaid Services (CMS) as part of the Congressionally mandated evaluation of SCHIP, this report reviews the research on crowd out after 10 years of experience with SCHIP and presents new data collected as part of the larger evaluation.

As Congress debated SCHIP reauthorization in 2007, there was much discussion on the crowd-out effects of SCHIP. This briefing in August 2007, provided an overview of the issue in the context of the current debate. A transcript of the briefing is provided; for additional resources, see the Alliance for Health Reform.

This report outlines the design and financing structure of SCHIP and synthesizes findings on the effect of the program on children’s health coverage. The findings indicate that SCHIP has contributed to a decline in the uninsured rate of low-income children, SCHIP’s target population, and concludes that crowd-out of private coverage under SCHIP is most likely between 25 and 50% of the increase in public coverage. 

This article examines the extent to which enrollees in SCHIP have dropped private insurance to enroll in public coverage.  The analysis shows that only 28% of SCHIP enrollees had private coverage in the six months prior to enrolling in the program. About half of these enrollees lost private coverage involuntarily, implying that 14% of all SCHIP enrollees had private coverage that they could have retained, but many report it is unaffordable.