Based on steadily rising enrollment in SCHIP and the recently reported decline in the number of uninsured children, from 9.9 million (13.9 percent) in 1997 to 7.8 million (10.8 percent) in 2001, 2 we know SCHIP has succeeded in expanding health insurance coverage among children. However, three years after SCHIP was enacted, when this evaluation got underway, understanding of the mechanisms that produced this overall result was still limited. While the need for information and analysis to guide federal and state policy was great and growing, little systematic analysis of the implications of states' program choices had been conducted. Although a body of literature on the program is emerging, knowledge is still limited about a host of important issues across the states and at the national level. For example, the reasons why some parents enroll their children and others do not, and the factors associated with disenrollment are still unclear. Likewise, knowledge about children's access to care and use of SCHIP benefits is limited, as is information about their parent's satisfaction with the care they receive. The impact of cost-sharing on utilization and satisfaction has been little studied. Empirical evidence to inform the debate about "crowd-out"--the substitution of SCHIP for private coverage also remains limited and equivocal.
Recognizing the importance of improving our knowledge about these issues and others, Congress appropriated $10 million for a comprehensive evaluation of SCHIP. The scope and purpose of this congressionally mandated evaluation are described in the next chapter.
2. Table 1.1, Family Care Component of 1997-2001 NHIS.