Three Essays on the State Children's Health Insurance Program

This dissertation studies the impact of public health insurance expansions under the 1997 State Children's Health Insurance Program (SCHIP) on different health outcomes. The first chapter estimates the impact of the SCHIP expansion on vaccination status among children under age 2 in a timely manner. I employ a simulated instrumental variables strategy to address the issue of selection into public health insurance programs. I find that being eligible for public health insurance is associated with a higher probability that a child receives recommended vaccine series without lengthy delays. In contrast, I find little effect for the single-dose vaccines such as varicella and MMR. In light of the positive health consequences associated with vaccinations, these results imply that expanding health insurance coverage could improve social welfare and the welfare of children with low socioeconomic status. The second chapter investigates the impact of health insurance expansions under SCHIP on birth outcomes among teenage mothers. I employ ordered probit and quantile regression to evaluate the existence of heterogeneous eligibility effects on birth outcomes of teenage mothers. Results show that increased public insurance income eligibility is associated with significant improvements in prenatal care utilization among teenage mothers. For teenage mothers with singleton births, the expanded insurance eligibility is associated with a small but significant increase in birth weight. I also find that pregnancies with lower health endowments may benefit more from the expanded eligibilities than pregnancies with great endowments. The third paper is co-authored with David Frisvold. In this paper, we examine the impact of SCHIP/Medicaid eligibility expansions for children on the prevalence of food insecurity among families with children. Our results suggest that being eligible for SCHIP/Medicaid reduces the probability that a family with children has low food security. We also find that SCHIP/Medicaid eligibility has stronger effects on families in states that had higher uninsured rates among children before SCHIP expansion and low income families with income less than 185 percent of the Federal Poverty Level.