The great recession of 2007-2009 and public insurance coverage for children in alabama: Enrollment and claims data from 1999-2011

Michael A. Morrisey, Justin Blackburn, David J. Becker, Bisakha Sen, Meredith L. Kilgore, Cathy Caldwell, Nir Menachemi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives. This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. Methods. We analyzed enrollment and claims data from Medicaid and the Children’s Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. Results. A one-percentage-point increase in a county’s unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state’s unemployment rate during the Great Recession, combined enrollment of children in Alabama’s public health insurance programs increased by 24% and total expenditures rose by 40%. Conclusion. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.

Original languageEnglish (US)
Pages (from-to)348-356
Number of pages9
JournalPublic Health Reports
Volume131
Issue number2
DOIs
StatePublished - Mar 1 2016

Fingerprint

Insurance Coverage
Health Insurance
Unemployment
Medicaid
Health Expenditures
Public Health
Cost Sharing
Budgets
Health Care Costs
Linear Models
Child Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The great recession of 2007-2009 and public insurance coverage for children in alabama : Enrollment and claims data from 1999-2011. / Morrisey, Michael A.; Blackburn, Justin; Becker, David J.; Sen, Bisakha; Kilgore, Meredith L.; Caldwell, Cathy; Menachemi, Nir.

In: Public Health Reports, Vol. 131, No. 2, 01.03.2016, p. 348-356.

Research output: Contribution to journalArticle

Morrisey, Michael A. ; Blackburn, Justin ; Becker, David J. ; Sen, Bisakha ; Kilgore, Meredith L. ; Caldwell, Cathy ; Menachemi, Nir. / The great recession of 2007-2009 and public insurance coverage for children in alabama : Enrollment and claims data from 1999-2011. In: Public Health Reports. 2016 ; Vol. 131, No. 2. pp. 348-356.
@article{302574f05cdd439f8cc9dc097bed7e5a,
title = "The great recession of 2007-2009 and public insurance coverage for children in alabama: Enrollment and claims data from 1999-2011",
abstract = "Objectives. This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. Methods. We analyzed enrollment and claims data from Medicaid and the Children’s Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. Results. A one-percentage-point increase in a county’s unemployment rate was associated with a 4.3{\%} increase in Medicaid enrollment, a 0.9{\%} increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7{\%}. Each percentage-point increase in unemployment was associated with a 6.2{\%} increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5{\%} and CHIP spending rising by 1.8{\%}. In response to the 6.4 percentage-point increase in the state’s unemployment rate during the Great Recession, combined enrollment of children in Alabama’s public health insurance programs increased by 24{\%} and total expenditures rose by 40{\%}. Conclusion. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.",
author = "Morrisey, {Michael A.} and Justin Blackburn and Becker, {David J.} and Bisakha Sen and Kilgore, {Meredith L.} and Cathy Caldwell and Nir Menachemi",
year = "2016",
month = "3",
day = "1",
doi = "10.1177/003335491613100219",
language = "English (US)",
volume = "131",
pages = "348--356",
journal = "Public Health Reports",
issn = "0033-3549",
publisher = "Association of Schools of Public Health",
number = "2",

}

TY - JOUR

T1 - The great recession of 2007-2009 and public insurance coverage for children in alabama

T2 - Enrollment and claims data from 1999-2011

AU - Morrisey, Michael A.

AU - Blackburn, Justin

AU - Becker, David J.

AU - Sen, Bisakha

AU - Kilgore, Meredith L.

AU - Caldwell, Cathy

AU - Menachemi, Nir

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Objectives. This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. Methods. We analyzed enrollment and claims data from Medicaid and the Children’s Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. Results. A one-percentage-point increase in a county’s unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state’s unemployment rate during the Great Recession, combined enrollment of children in Alabama’s public health insurance programs increased by 24% and total expenditures rose by 40%. Conclusion. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.

AB - Objectives. This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. Methods. We analyzed enrollment and claims data from Medicaid and the Children’s Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. Results. A one-percentage-point increase in a county’s unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state’s unemployment rate during the Great Recession, combined enrollment of children in Alabama’s public health insurance programs increased by 24% and total expenditures rose by 40%. Conclusion. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.

UR - http://www.scopus.com/inward/record.url?scp=84959212848&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959212848&partnerID=8YFLogxK

U2 - 10.1177/003335491613100219

DO - 10.1177/003335491613100219

M3 - Article

C2 - 26957670

AN - SCOPUS:84959212848

VL - 131

SP - 348

EP - 356

JO - Public Health Reports

JF - Public Health Reports

SN - 0033-3549

IS - 2

ER -