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12-02-2013 | Article

Uninsured children persist when affordability and eligibility are not jointly considered


Free abstract

medwireNews: Health insurance coverage with greater premium contribution requirements decreases enrollment in public coverage among children through the Children's Health Insurance Program (CHIP).

Overall, according to a simulation study in Health Services Research, one can expect minimal changes in coverage outcome despite a more inclusive eligibility criteria toward higher income families when premium schedules demand a contribution that is more than modest.

"[I]f you just implemented all these state health exchanges but didn't address the issue of affordability, you probably aren't going to change health insurance outcomes that much," explained primary author, Carole Gresenz (Georgetown University, Washington DC) to medwireNews. "It speaks to the importance of the dual issues of availability and affordability of healthcare."

Gresenz and colleagues simulated 12 scenarios that were based on alterations of availability and affordability, which were represented by three income eligibility thresholds for CHIP as a percentage of the federal poverty line (FPL) (200%, 300%, and 400%) and four annual premium contributions that entailed zero, low (<$ 361), medium ($ 361-$ 720), or high (>$ 720) schedules.

The simulation represented "what coverage outcomes would look like among children nationally under a stylized CHIP program implemented uniformly across all states," explain the study authors. The expected percentages of children with public coverage, private coverage, and no coverage were then calculated.

An income eligibility threshold of 200% FPL without any premium led to 38% of children enrolled in public coverage versus 37% when an income eligibility threshold of 400% FPL and a high premium was in effect.

"We wanted to see how much bang we would get for just making insurance more available [and] found that health insurance outcomes for children were relatively unchanged," Gresenz said, even if it hinders an unwanted decrease in private insurance coverage due to public coverage availability, or "crowd-out."

Gresenz underscored the significance of the finding, despite initiating the study when the Affordable Care Act was, as she described, "just a glimmer in Obama's eye," and health exchanges were not yet a reality. "[The finding] is still important because the [legislation's]... health insurance exchanges address the issue of availability [while its] subsidies… address the issue of affordability."

Despite a high eligibility and affordability, the study still discovered a subset of children who remained uninsured. Gresenz attributed this occurrence to a third issue that insurance exchanges will have to consider. "What that speaks to is the importance of making any process of enrolling in health insurance coverage transparent and easy to navigate for families," she said.

By Peter Sergo, medwireNews Reporter