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SCHIP Data: An Author RespondsI totally concur with Mitchell Roob about the need for more research on the effects of health insurance coverage on children’s health and well-being. Roob bemoans the lack of evidence linking the State Children’s Health Insurance Program (SCHIP) to improved health and well-being of children. While there is no Indiana-specific research on this topic, such effects have been found for children in other places.1 Conducting research on this topic is challenging for many reasons. First, one would not expect health insurance coverage to have large, easily visible impacts on health in a general sample of children because less than 1 percent (0.54 percent) are classified as being in poor health, and another 2.6 percent are classified as being in fair health, leaving room for substantial short-term improvement among only a small subset of children. Since the children who have the greatest potential for experiencing rapid improvements in health constitute a small share of all children, very large samples are needed to identify reliable impacts for children with health problems, making these studies costly. Second, it is difficult to establish a valid counterfactual showing the health and well-being that children would have experienced had they not been enrolled in public programs. Third, while underlying health problems may be diagnosed at higher rates among children who have coverage, potentially yielding long-lasting positive effects on children’s lives, identifying such long-term gains is extremely difficult and costly. In short, shoring up research on this important topic requires a realistic understanding of what health insurance can accomplish for children, substantial resources, and recognition of the analytic challenges inherent in such studies. Roob is right to call for additional research on this topic, and I hope that additional resources are forthcoming for such work.
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