Health Insurance for Poor Women and Children in the U.S.: Lessons from the Past Decade

Abstract

The Medicaid program, which provides health insurance coverage to low income women and children, has expanded dramatically over the past decade. This expansion provides a natural laboratory for learning about the effect of public health insurance eligibility on insurance coverage, health care utilization, and health outcomes. This paper provides an over-view of what has been learned about these questions from studying the expansions. Medicaid eligibility rose steeply over the 1984-1992 period, but coverage rose much less sharply, due to limited takeup of benefits. This is partly due to the fact that many eligibles already had private insurance coverage, and evidence suggests that a large share of new enrollees dropped their private coverage to join the program. Nevertheless, utilization of preventive care rose substantially as a result of the expansions, and there were significant improvements in health outcomes, specifically infant and child mortality. While these mortality reductions came at significa...