Encouraging eligible children's participation in public health insurance: The role of national awareness campaigns

This research examines the effectiveness of two national awareness campaigns in their ability to increase rates of insurance coverage among low-income children potentially eligible for public health insurance programs. The campaigns evaluated are the 2005 and 2006 Robert Wood Johnson Foundation's Cover the Uninsured Week and the Back to School Campaign. Differential rates of exposure to earned media (television, radio, and print news coverage) are estimated for large metropolitan area in the United States. The exposure variables are matched to children in the Current Population Survey (CPS). Controlling for relevant individual and family characteristics and metropolitan area, the impact of each type of exposure is estimated. Two outcomes are considered: a campaign's ability to encourage enrollment among those uninsured prior to exposure and its ability to sustain coverage among those that are already insured in the pre-exposure period. The campaigns are posited to assist in overcoming one of three types of cost to enrollment: information, process, and outcome costs (perceived outcome) of enrollment. The results are also considered in light of the knowledge gap hypothesis.;This research produces evidence that Back to School print coverage increased rates of coverage by as much as 2.5 percentage points. Children living in areas with more Back to School print coverage were more likely to maintain insurance coverage from one year to the next. This result holds when considering all children in metropolitan areas and low-income children estimated to be eligible in the pre or post-exposure period. Looking at subpopulations of eligible children, there is evidence that campaigns work best as encouraging insurance enrollment for children that are in good health, that are not Hispanic and that are in families with more than one child and that are below 133 percent of the Federal Poverty Level (FPL). At the same time, there is evidence that the campaigns work best at maintaining coverage among children that are not black and are U.S. born and that are in families that have higher educational attainment, do not have full time workers, have multiple children, and have incomes greater than 133 percent FPL.;Also presented as an appendix to this research are methods to harmonize insurance coverage in the CPS for all years since the inception of the State Children's Health Insurance Program. Using the 1997-2007 CPS methods are introduced to correct for various methodological and conceptual changes to the measurement of health insurance coverage in the CPS, which is the source most often used for documenting trends in coverage. Included in this, is a novel approach for correcting the change in estimates due to the introduction of the health insurance verification question in 2000. This harmonized time series can be used going forward as further attempts are made to disentangle the effects of outreach and education in stimulating enrollment in public health insurance programs.