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The Effects of Premiums and Cost Sharing on Low-Income Populations: Updated Review of Research Findings

Issue Brief
  1. See Maine Department of Health and Human Services, 1115 Waiver Application, http://www.maine.gov/dhhs/oms/documents/Draft_MaineCare_1115_application.pdf; State of Wisconsin BadgerCare Reform Demonstration Project, Coverage of Adults Without Dependent Children with Income at or Below 100 Percent of the Federal Poverty Level, Draft 1115 Demonstration Waiver Amendment Application, https://www.dhs.wisconsin.gov/badgercareplus/clawaiver-app.pdf; Office of the Governor, Kentucky Health: Helping to Engage and Achieve Long Term Health, https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ky/ky-health-pa.pdf; and Indiana Family and Social Services Administration, Health Indiana Plan (HIP) Section 1115 Waiver Extension Application, https://www.in.gov/fssa/hip/files/HIP_Extension_Waiver_FINAL1.pdf.

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  2. Tricia Brooks, et. al., Medicaid and HCIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2017: Findings form a 50-State Survey, (Washington, DC: Kaiser Family Foundation, January 2017), http://kff.org/report-section/medicaid-and-chip-eligibility-enrollment-renewal-and-cost-sharing-policies-as-of-january-2017-introduction/.

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  3. Ibid.

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  4. Ibid.

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  5. Gery P Guy, et. al., “The Role of Public and Private Insurance Expansions and Premiums for Low-Income Parents: Lessons from State Experiences,” Medical Care 55, 3 (March 2017):236-243.

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  6. Salam Abdus, et. al., “Children’s Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children,” Health Affairs 33, no.8 (August 2014): 1353-1360.

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  7. Carole R Gresenz, Sarah E Edgington, Miriam J Laugesen and Jose J Escarce, “Income Eligibility Thresholds, Premium Contributions, and Children’s Coverage Outcomes: A Study of CHIP Expansions,” Health Services Research 48:2, Part II (April 2013):884-902.

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  8. Gery P Guy, Jr., E. Kathleen Adams, and Adam Atherly, “Public and Private Health Insurance Premiums: How do they Affect Health Insurance Status of Low-Income Childless Adults?” Inquiry 49 (Spring 2012):52-64.

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  9. Jack Hadley, et. al., “Insurance Premiums and Insurance Coverage of Near-Poor Children,” Inquiry 43, 4 (Winter 2006/2007).

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  10. Genevieve Kenney, Jack Hadley, and Fredric Blavin, “Effects of Public Premiums on Children’s Health Insurance Coverage: Evidence from 1999 to 2003,” Inquiry 43 (Winter 2006/2007):345-361.

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  11. The Lewin Group, Healthy Indiana Plan 2.0: POWER Account Contribution Assessment, Prepared for Indiana Family and Social Services Administration (FSSA), (Washington, DC: Lewin Group, March 2017).

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  12. MaryBeth Musumeci, et. al., An Early Look at Medicaid Expansion Waiver Implementation in Michigan and Indiana, (Washington, DC: Kaiser Family Foundation, January 2017), http://kff.org/report-section/an-early-look-at-medicaid-expansion-waiver-implementation-in-michigan-and-indiana-key-findings/.

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  13. James Marton et. al., “Estimating Premium Sensitivity for Children’s Public Health Insurance Coverage: Selection but No Death Spiral,” Health Services Research 50, 2 (April 2015): 579-598.

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  14. Laura Dague, “The Effect of Medicaid Premiums on Enrollment: A Regression Discontinuity Approach,” Journal of Health Economics 37 (May 2014): 1-12.

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  15. Michael Hendryx, et al., “Effects of a Cost-Sharing Policy on Disenrollment from a State Health Insurance Program,” Social Work in Public Health, 27, 7 (2012):671-686.

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  16. Michael M Morrisey, et.al., “The Effects of Premium Changes on ALL Kids, Alabama’s CHIP Program,” Medicare & Medicaid Research Review 2,3 (2012):E1-E17.

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  17. Bill J Wright, et. al., “Raising Premiums and Other Costs for Oregon Health Plan Enrollees Drove Many to Drop Out,” Health Affairs, 29, 12 (December 2010):2311-2316.

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  18. Michael R Cousineau, Kai-Ya Tsai, and Howard A Kahn, “Two Responses to a Premium Hike in a Program for Uninsured Kids: 4 in 5 Families Stay In as Enrollment Shrinks by a Fifth,” Health Affairs 31, 2 (February 2012):360-366.

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  19. James Marton, Patricia G Ketsche, and Mei Zhou, “SCHIP Premiums, Enrollment, and Expenditures: A Two State, Competing Risk Analysis,” Health Economics 19 (2010):772-791.

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  20. James Marton and Jeffery C Talbert, “CHIP Premiums, Health Status, and the Insurance Coverage of Children,” Inquiry 47, 3 (Fall 2010):199-214.

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  21. Stephen Zuckerman, Dawn M Miller, and Emily Shelton Page, “Missouri’s 2005 Medicaid Cuts: How Did they Affect Enrollees and Providers?” Health Affairs 28, 2, (2009):w335-w345.

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  22. Jill B Herndon, W Bruce Vogel, Richard L Bucciarelli and Elizabeth A Shenkman, “The Effect of Premium Changes on SCHIP Enrollment Duration,” Health Services Research 43, 2 (April 2008):458-477.

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  23. James Marton, “The Impact of the Introduction of Premiums into a SCHIP Program,” Journal of Policy Analysis and Management 26 (2007):237-255.

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  24. Genevieve Kenney, et. al., “Assessing Potential Enrollment and Budgetary Effects of SCHIP Premiums: Findings from Arizona and Kentucky,” Health Services Research 42, 6 Part 2 (2007):2354-2372.

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  25. Gina A Livermore, et. al., “Premium Increases in State Health Insurance Programs: Lessons from a Case Study of the Massachusetts Medicaid Buy-in Program,” Inquiry 44 (Winter 2007):428-442.

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  26. Genevieve Kenney, et. al., “The Effects of Premium Increases on Enrollment in SCHIP Programs: Findings from Three States,” Inquiry, 43, 4 (Winter 2006/2007):378-92.

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  27. Tricia J Johnson, Mary Rimsza, and William G Johnson, “The Effects of Cost-Shifting in the State Children’s Health Insurance Program,” American Journal of Public Health, 96, 4 (April 2006):709-715.

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  28. Bill J Wright et. al., “The Impact of Increased Cost Sharing on Medicaid Enrollees,” Health Affairs 24, no. 4 (Jul/Aug 2005):1106-1116.

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  29. Matthew J Carlson and Bill Wright, “The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population,” Prepared for the Office for Oregon Health Policy and Research, Sociology Faculty Publications and Presentations, Paper 14 (March 2005).

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  30. Rachel Solotaroff, et. al., “Medicaid Programme Changes and the Chronically Ill: Early Results from a Prospective Cohort Study of the Oregon Health Plan,” Chronic Illness 1, (2005): 191-205.

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  31. Gene LeCouteur, Michael Perry, Samantha Artiga and David Rousseau, The Impact of Medicaid Reductions in Oregon: Focus Group Insights, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2004).

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  32. Utah Department of Health Center for Health Data, Utah Primary Care Network Disenrollment Report, (Salt Lake City, UT: Utah Department of Health Center for Health Data, Office of Health Care Statistics, August 2004).

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  33. Mark Gardner and Janet Varon, Moving Immigrants from a Medicaid Look-Alike Program to Basic Health in Washington State: Early Observations, (Washington, DC: Kaiser Family Foundation, May 2004).

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  34. Maryland Department of Health and Mental Hygiene, Maryland Children’s Health Insurance Program: Assessment of the Impact of Premiums, (Baltimore, MD: Department of Health and Mental Hygiene, April 2004).

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  35. John McConnell and Neal Wallace, Impact of Premium Changes in the Oregon Health Plan, Prepared for the Office for Oregon Health Policy & Research, (Portland, OR: Oregon Health & Science University, February 2004.

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  36. Norma I Gavin, et. al., Evaluation of the BadgerCare Medicaid Demonstration, Prepared by RTI International and MayaTech Corp. for the Centers for Medicare & Medicaid Services, (Research Triangle Park, NC: RTI International and MayaTech Corporation, December 2003).

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  37. Monette Goodrich, Joan Alker, and Judith Solomon, Families at Risk: The Impact of Premiums on Children and Parents in Husky A, Policy Brief (Washington, DC: Georgetown Center for Children and Families, November 2003), http://ccf.georgetown.edu/wp-content/uploads/2012/03/Far%20-%20impact%20of%20premiums.pdf.

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  38. Elizabeth Shenkman, et. al., “Disenrollment and Re-Enrollment Patters in a SCHIP Program,” Health Care Financing Review 23, 3 (Spring 2002):47-63.

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  39. Leighton Ku and Teresa A Coughlin, “Sliding-Scale Premium Health Insurance Programs: Four States’ Experiences,” Inquiry 36, 4 (Winter 1999/2000).

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  40. Gery P Guy, et. al., “The Role of Public and Private Insurance Expansions and Premiums for Low-Income Parents: Lessons from State Experiences,” Medical Care 55, 3 (March 2017):236-243.

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  41. Salam Abdus, et. al., “Children’s Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children,” Health Affairs 33, no.8 (August 2014): 1353-1360.

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  42. Carole R Gresenz, Sarah E Edgington, Miriam J Laugesen and Jose J Escarce, “Income Eligibility Thresholds, Premium Contributions, and Children’s Coverage Outcomes: A Study of CHIP Expansions,” Health Services Research 48:2, Part II (April 2013):884-902.

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  43. Bill J Wright, et. al., “Raising Premiums and Other Costs for Oregon Health Plan Enrollees Drove Many to Drop Out,” Health Affairs, 29, 12 (December 2010):2311-2316.

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  44. James Marton, Patricia G Ketsche, and Mei Zhou, “SCHIP Premiums, Enrollment, and Expenditures: A Two State, Competing Risk Analysis,” Health Economics 19 (2010):772-791.

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  45. Genevieve Kenney, et. al., “Assessing Potential Enrollment and Budgetary Effects of SCHIP Premiums: Findings from Arizona and Kentucky,” Health Services Research 42, 6 Part 2 (2007):2354-2372.

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  46. Bill J Wright et. al., “The Impact of Increased Cost Sharing on Medicaid Enrollees,” Health Affairs 24, no. 4 (Jul/Aug 2005):1106-1116.

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  47. Matthew J Carlson and Bill Wright, “The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population,” Prepared for the Office for Oregon Health Policy and Research, Sociology Faculty Publications and Presentations, Paper 14 (March 2005).

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  48. Gene LeCouteur, Michael Perry, Samantha Artiga and David Rousseau, The Impact of Medicaid Reductions in Oregon: Focus Group Insights, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2004).

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  49. Utah Department of Health Center for Health Data, Utah Primary Care Network Disenrollment Report, (Salt Lake City, UT: Utah Department of Health Center for Health Data, Office of Health Care Statistics, August 2004).

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  50. Michael Hendryx, et al., “Effects of a Cost-Sharing Policy on Disenrollment from a State Health Insurance Program,” Social Work in Public Health, 27, 7 (2012):671-686.

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  51. Bill J Wright et. al., “The Impact of Increased Cost Sharing on Medicaid Enrollees,” Health Affairs 24, no. 4 (Jul/Aug 2005):1106-1116.

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  52. Matthew J Carlson and Bill Wright, “The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population,” Prepared for the Office for Oregon Health Policy and Research, Sociology Faculty Publications and Presentations, Paper 14 (March 2005).

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  53. Gene LeCouteur, Michael Perry, Samantha Artiga and David Rousseau, The Impact of Medicaid Reductions in Oregon: Focus Group Insights, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2004).

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  54. Utah Department of Health Center for Health Data, Utah Primary Care Network Disenrollment Report, (Salt Lake City, UT: Utah Department of Health Center for Health Data, Office of Health Care Statistics, August 2004).

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  55. Matthew J Carlson and Bill Wright, “The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population,” Prepared for the Office for Oregon Health Policy and Research, Sociology Faculty Publications and Presentations, Paper 14 (March 2005).

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  56. Rachel Solotaroff, et. al., “Medicaid Programme Changes and the Chronically Ill: Early Results from a Prospective Cohort Study of the Oregon Health Plan,” Chronic Illness 1, (2005): 191-205.

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  57. Gery P Guy, et. al., “The Role of Public and Private Insurance Expansions and Premiums for Low-Income Parents: Lessons from State Experiences,” Medical Care 55, 3 (March 2017):236-243.

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  58. Genevieve Kenney, Jack Hadley, and Fredric Blavin, “Effects of Public Premiums on Children’s Health Insurance Coverage: Evidence from 1999 to 2003,” Inquiry 43 (Winter 2006/2007):345-361.

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  59. Michael M Morrisey, et.al., “The Effects of Premium Changes on ALL Kids, Alabama’s CHIP Program,” Medicare & Medicaid Research Review 2,3 (2012):E1-E17.

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  60. Jill B Herndon, W Bruce Vogel, Richard L Bucciarelli and Elizabeth A Shenkman, “The Effect of Premium Changes on SCHIP Enrollment Duration,” Health Services Research 43, 2 (April 2008):458-477.

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  61. Genevieve Kenney, et. al., “The Effects of Premium Increases on Enrollment in SCHIP Programs: Findings from Three States,” Inquiry, 43, 4 (Winter 2006/2007):378-92.

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  62. Bill J Wright et. al., “The Impact of Increased Cost Sharing on Medicaid Enrollees,” Health Affairs 24, no. 4 (Jul/Aug 2005):1106-1116.

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  63. Matthew J Carlson and Bill Wright, “The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population,” Prepared for the Office for Oregon Health Policy and Research, Sociology Faculty Publications and Presentations, Paper 14 (March 2005).

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  64. Rachel Solotaroff, et. al., “Medicaid Programme Changes and the Chronically Ill: Early Results from a Prospective Cohort Study of the Oregon Health Plan,” Chronic Illness 1, (2005): 191-205.

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  65. John McConnell and Neal Wallace, Impact of Premium Changes in the Oregon Health Plan, Prepared for the Office for Oregon Health Policy & Research, (Portland, OR: Oregon Health & Science University, February 2004.

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  66. The Lewin Group, Healthy Indiana Plan 2.0: POWER Account Contribution Assessment, Prepared for Indiana Family and Social Services Administration (FSSA), (Washington, DC: Lewin Group, March 2017).

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  67. Bill J Wright et. al., “The Impact of Increased Cost Sharing on Medicaid Enrollees,” Health Affairs 24, no. 4 (Jul/Aug 2005):1106-1116.

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  68. Matthew J Carlson and Bill Wright, “The Impact of Program Changes on Enrollment, Access, and Utilization in the Oregon Health Plan Standard Population,” Prepared for the Office for Oregon Health Policy and Research, Sociology Faculty Publications and Presentations, Paper 14 (March 2005).

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  69. Office of the Executive Director, 2003 Utah Public Health Outcome Measures Report, (Salt Lake City, UT: UT Department of Health, December 2003), http://www.hpm.umn.edu/ ambul_db/db/pdflibrary/ DBfile_49007.pdf

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  70. Rachel Solotaroff, et. al., “Medicaid Programme Changes and the Chronically Ill: Early Results from a Prospective Cohort Study of the Oregon Health Plan,” Chronic Illness 1, (2005): 191-205.

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  71. Gene LeCouteur, Michael Perry, Samantha Artiga and David Rousseau, The Impact of Medicaid Reductions in Oregon: Focus Group Insights, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2004).

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  72. John McConnell and Neal Wallace, Impact of Premium Changes in the Oregon Health Plan, Prepared for the Office for Oregon Health Policy & Research, (Portland, OR: Oregon Health & Science University, February 2004.

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  73. The Lewin Group, Healthy Indiana Plan 2.0: POWER Account Contribution Assessment, Prepared for Indiana Family and Social Services Administration (FSSA), (Washington, DC: Lewin Group, March 2017).

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  74. Salam Abdus, et. al., “Children’s Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children,” Health Affairs 33, no.8 (August 2014): 1353-1360.

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  75. Genevieve Kenney, Jack Hadley, and Fredric Blavin, “Effects of Public Premiums on Children’s Health Insurance Coverage: Evidence from 1999 to 2003,” Inquiry 43 (Winter 2006/2007):345-361.

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  76. Michael M Morrisey, et.al., “The Effects of Premium Changes on ALL Kids, Alabama’s CHIP Program,” Medicare & Medicaid Research Review 2,3 (2012):E1-E17.

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  77. Genevieve Kenney, et. al., “The Effects of Premium Increases on Enrollment in SCHIP Programs: Findings from Three States,” Inquiry, 43, 4 (Winter 2006/2007):378-92.

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  78. James Marton et. al., “Estimating Premium Sensitivity for Children’s Public Health Insurance Coverage: Selection but No Death Spiral,” Health Services Research 50, 2 (April 2015): 579-598.

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  79. Michael M Morrisey, et.al., “The Effects of Premium Changes on ALL Kids, Alabama’s CHIP Program,” Medicare & Medicaid Research Review 2,3 (2012):E1-E17.

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  80. James Marton and Jeffery C Talbert, “CHIP Premiums, Health Status, and the Insurance Coverage of Children,” Inquiry 47, 3 (Fall 2010):199-214.

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  81. Jill B Herndon, W Bruce Vogel, Richard L Bucciarelli and Elizabeth A Shenkman, “The Effect of Premium Changes on SCHIP Enrollment Duration,” Health Services Research 43, 2 (April 2008):458-477.

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  82. Ibid.

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  83. Rachel Solotaroff, et. al., “Medicaid Programme Changes and the Chronically Ill: Early Results from a Prospective Cohort Study of the Oregon Health Plan,” Chronic Illness 1, (2005): 191-205.

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  84. James Marton et. al., “Estimating Premium Sensitivity for Children’s Public Health Insurance Coverage: Selection but No Death Spiral,” Health Services Research 50, 2 (April 2015): 579-598.

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  85. Michael M Morrisey, et.al., “The Effects of Premium Changes on ALL Kids, Alabama’s CHIP Program,” Medicare & Medicaid Research Review 2,3 (2012):E1-E17.

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  86. Joseph P Newhouse and the Insurance Experiment Group, Free For All? Lessons from the RAND Health Insurance Experiment, (Arlington, VA, RAND, 1993).

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  87. Amitabh Chandra, Jonathan Gruber and Robin McKnight, “The Impact of Patient Cost-Sharing on Low-Income Populations: Evidence from Massachusetts,” Journal of Health Economics 33 (2014): 57-66.

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  88. Charles Stoecker, Alexandra M Stewart, and Megan C Lindley, “The Cost of Cost-Sharing: The Impact of Medicaid Benefit Design on Influence Vaccination Uptake,” Vaccines 5, 8, (March 2017).

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  89. Bisakha Sen, et. al., “Can Increases in CHIP Copayments Reduce Program Expenditures on Prescription Drugs?” Medicare & Medicaid Research Review 4, 2 (May 2014).

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  90. Bisakha Sen, et. al., “Did Copayment Changes Reduce Health Service Utilization among CHIP Enrollees? Evidence from Alabama,” Health Services Research 47, 4 (September 2012):1303-1620.

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  91. Daniel M Hartung, et. al., “Impact of a Medicaid Copayment Policy on Prescription Drug and Health Services Utilization in a Fee-for-service Medicaid Population,” Medical Care 46, 6 (June 2008):565-572.

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  92. Office of the Executive Director, 2003 Utah Public Health Outcome Measures Report, (Salt Lake City, UT: UT Department of Health, December 2003), http://www.hpm.umn.edu/ ambul_db/db/pdflibrary/ DBfile_49007.pdf

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  93. Ibid.

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  94. Bisakha Sen, et. al., “Did Copayment Changes Reduce Health Service Utilization among CHIP Enrollees? Evidence from Alabama,” Health Services Research 47, 4 (September 2012):1303-1620.

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  95. Bill J Wright, et. al., “Raising Premiums and Other Costs for Oregon Health Plan Enrollees Drove Many to Drop Out,” Health Affairs, 29, 12 (December 2010):2311-2316.

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  96. Leighton Ku, et. al., The Effects of Copayments on the Use of Medical Services and Prescription Drugs in Utah’s Medicaid Program, (Washington, DC: Center on Budget and Policy Priorities, November 2004).

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  97. Gery P Guy Jr., “The Effects of Cost Sharing on Access to Care among Childless Adults.” Health Services Research, 45, 6 Pt. 1 (December 2010): 1720-1739.

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  98. Vicki Fung, et. al., “Financial Barriers to Care Among Low-Income Children with Asthma: Health Care Reform Implications,” JAMA Pediatrics 168, 7 (July 2014):649-656.

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  99. Office of the Executive Director, 2003 Utah Public Health Outcome Measures Report, (Salt Lake City, UT: UT Department of Health, December 2003), http://www.hpm.umn.edu/ ambul_db/db/pdflibrary/ DBfile_49007.pdf

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  100. Leighton Ku, et. al., The Effects of Copayments on the Use of Medical Services and Prescription Drugs in Utah’s Medicaid Program, (Washington, DC: Center on Budget and Policy Priorities, November 2004).

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  101. Deliana Kostova and Jared Fox, “Chronic Health Outcomes and Prescription Drug Copayments in Medicaid,” Medical Care, published ahead of print (February 2017).

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  102. Marisa Elena Domino, et. al., “Increasing Time Cost and Copayments for Prescription Drugs: An Analysis of Policy Changes in a Complex Environment,” Health Services Research 46, 3 (June 2011):900-919.

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  103. Joel F Farley, “Medicaid Prescription Cost Containment and Schizophrenia: A Retrospective Examination,” Medical Care 48, 5 (May 2010): 440-447.

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  104. Bisakha Sen, et. al., “Can Increases in CHIP Copayments Reduce Program Expenditures on Prescription Drugs?” Medicare & Medicaid Research Review 4, 2 (May 2014).

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  105. Michael Chernew, et. al., “Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care,” Journal of General Internal Medicine 23, 8 (August 2008):1131-1136.

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  106. Sujha Subramanian, “Impact of Medicaid Copayments on Patients with Cancer,” Medical Care 49, 9 (September 2011): 842-847.

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  107. Office of the Executive Director, 2003 Utah Public Health Outcome Measures Report, (Salt Lake City, UT: UT Department of Health, December 2003), http://www.hpm.umn.edu/ ambul_db/db/pdflibrary/ DBfile_49007.pdf

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  108. James Marton, et. al., “The Effects of Medicaid Policy Changes on Adults’ Service Use Patterns in Kentucky and Idaho,” Medicare & Medicaid Research Review 2, 4 (February 2013).

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  109. Ibid.

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  110. Bisakha Sen, et. al., “Can Increases in CHIP Copayments Reduce Program Expenditures on Prescription Drugs?” Medicare & Medicaid Research Review 4, 2 (May 2014).

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  111. Amitabh Chandra, Jonathan Gruber and Robin McKnight, “The Impact of Patient Cost-Sharing on Low-Income Populations: Evidence from Massachusetts,” Journal of Health Economics 33 (2014): 57-66.

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  112. Deliana Kostova and Jared Fox, “Chronic Health Outcomes and Prescription Drug Copayments in Medicaid,” Medical Care, published ahead of print (February 2017).

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  113. Sujha Subramanian, “Impact of Medicaid Copayments on Patients with Cancer,” Medical Care 49, 9 (September 2011): 842-847.

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  114. Daniel M Hartung, et. al., “Impact of a Medicaid Copayment Policy on Prescription Drug and Health Services Utilization in a Fee-for-service Medicaid Population,” Medical Care 46, 6 (June 2008):565-572.

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  115. Deliana Kostova and Jared Fox, “Chronic Health Outcomes and Prescription Drug Copayments in Medicaid,” Medical Care, published ahead of print (February 2017).

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  116. Jessica Greene, Rebecca M Sacks, and Sara B McMenamin, “The Impact of Tobacco Dependence Treatment Coverage and Copayments in Medicaid,” American Journal of Preventive Medicine 46, 4 (April 2014):331-336.

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  117. Vicki Fung, et. al., “Financial Barriers to Care Among Low-Income Children with Asthma: Health Care Reform Implications,” JAMA Pediatrics 168, 7 (July 2014):649-656.

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  118. Leah Zallman, et. al., “Affordability of Health Care Under Publicly Subsidized Insurance After Massachusetts Health Care Reform: A Qualitative Study of Safety Net Patients,” International Journal for Equity in Health 14 (October 2015):112.

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  119. Leah Zallman, et.al., “Perceived Affordability of Health Insurance and Medical Financial Burdens Five Years in to Massachusetts Health Reform,” International Journal for Equity in Health 14 (October 2015):113.

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  120. Bill J Wright, et. al., “Raising Premiums and Other Costs for Oregon Health Plan Enrollees Drove Many to Drop Out,” Health Affairs, 29, 12 (December 2010):2311-2316.

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  121. Gene LeCouteur, Michael Perry, Samantha Artiga and David Rousseau, The Impact of Medicaid Reductions in Oregon: Focus Group Insights, (Washington, DC: Kaiser Commission on Medicaid and the Uninsured, December 2004).

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  122. Office of the Executive Director, 2003 Utah Public Health Outcome Measures Report, (Salt Lake City, UT: UT Department of Health, December 2003), http://www.hpm.umn.edu/ ambul_db/db/pdflibrary/ DBfile_49007.pdf

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  123. Deliana Kostova and Jared Fox, “Chronic Health Outcomes and Prescription Drug Copayments in Medicaid,” Medical Care, published ahead of print (February 2017).

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  124. Vicki Fung, et. al., “Financial Barriers to Care Among Low-Income Children with Asthma: Health Care Reform Implications,” JAMA Pediatrics 168, 7 (July 2014):649-656.

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  125. Peter J Cunningham, Affording Prescription Drugs: Not Just a Problem for the Elderly, (Washington, DC: Center for Studying Health System Change, April 2002), http://www.hschange.org/CONTENT/430/430.pdf.

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  126. Rachel Solotaroff, et. al., “Medicaid Programme Changes and the Chronically Ill: Early Results from a Prospective Cohort Study of the Oregon Health Plan,” Chronic Illness 1, (2005): 191-205.

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  127. Lindsay M Sabik and Sabina Ohri Gandhi, “Copayments and Emergency Department use Among Adult Medicaid Enrollees,” Health Economics 25 (May 2016):529-542.

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  128. Karoline Mortensen, “Copayments Did Not Reduce Medicaid Enrollees’ Nonemergency Use of Emergency Departments,” Health Affairs 29, 9 (September 2010): 1643-1650.

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  129. Mona Siddiqui, Eric T Roberts, and Craig E Pollack, “The Effects of Emergency Department Copayments for Medicaid Beneficiaries Following the Deficit Reduction Act of 2005,” JAMA Internal Medicine 175,3 (March 2015):393-398.

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  130. Bisakha Sen, et. al., “Health Expenditure Concentration and Characteristics of High-Cost Enrollees in CHIP,” Inquiry 53 (May 2016):1-9.

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  131. Marisa Elena Domino, et. al., “Increasing Time Cost and Copayments for Prescription Drugs: An Analysis of Policy Changes in a Complex Environment,” Health Services Research 46, 3 (June 2011):900-919.

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  132. Maryland Department of Health and Mental Hygiene, Estimated Medicaid Savings and Program Impacts of Service Limitations, Copayments, and Premiums, (Baltimore, MD: Maryland Department of Health and Mental Hygiene, December 2010), https://mmcp.dhmh.maryland.gov/Documents/medicaidsavingsJCRfinal12-10.pdf.

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  133. Health Management Associates, Co-pays for Nonemergent Use of Hospital Emergency Rooms: Cost Effectiveness and Feasibility Analysis, Prepared for the Texas Health and Human Services Commission, (Austin, TX: Health and Human Services Commission, May 2008).

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