Goal Conflict in the State Children's Health Insurance Program
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Date
2010-06-16
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[Bloomington, Ind.] : Indiana University
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Abstract
This dissertation develops goal conflict theory and its application to intergovernmental public policy through state-level empirical analysis of the State Children's Health Insurance Program (SCHIP) from 1999-2007. This program was selected for analysis because it is a program in which goal conflict has been readily manifest, particularly during the 2007 SCHIP reauthorization attempts.
Goal conflict in SCHIP is operationalized as enrollment of higher-income children and of adults, and is examined in terms of fiscal impact on the federal government and on various measures of program success including enrollment of low-income children in SCHIP.
Enrollment of adults was found to increase federal costs within a state (federal funding formulas notwithstanding). Further analysis showed that rules governing the fiscal impact of enrollment expansions significantly affected the choice to engage (or not engage) in these activities.
In examining the effect of enrollment of non-targeted populations on federal spending between and within states, the analysis demonstrated that while formula factors--not enrollment choices--drive federal spending between states, enrollment of adults increases spending within states and enrollment of higher-income children appears to decrease spending within states.
In fixed-effects models estimating the impact of enrollment of adults and higher-income children on enrollment of targeted children, enrollment of adults was consistently found to negatively impact enrollment of targeted children and enrollment of higher-income children was found to improve enrollment of targeted children.
A final empirical analysis focused on the policy choices of adult and higher-income child enrollment as dependent variables. Goal conflict variables, in addition to capacity variables, were shown to be significant predictors of these state policy choices even after controlling for state (random) effects.
Description
Thesis (Ph.D.) - Indiana University, Public Affairs, 2009
Keywords
federalism, fund diversion, goal conflict, health Insurance, health policy, SCHIP
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Attribution Non-commercial No Derivatives (by-nc-nd)
http://creativecommons.org/licenses/by-nc-nd/4.0/
http://creativecommons.org/licenses/by-nc-nd/4.0/
Type
Doctoral Dissertation