Effects of a cost-sharing policy on disenrollment from a state health insurance program

Subsidized public health insurance programs face financial difficulties and are increasingly implementing policies to pass on greater costs to low-income enrollees. Results of a stratified, random sample of 1,153 enrollees and disenrollees of a state program after introduction of increased cost sharing revealed three main reasons for disenrollment, which varied by enrollee income: finding other coverage, becoming financially ineligible, or dropping coverage as too expensive. Seventeen percent of disenrollees cited cost sharing as a reason for disenrollment. Persons who disenrolled were more likely to be younger adults, male, and have fewer children. Persons who disenrolled reported greater subsequent out-of-pocket costs, more difficulty providing coverage for children, and less access to care than persons who stayed enrolled. Most enrollees stayed enrolled despite the cost sharing increases, and persons who did disenroll left for a variety of reasons, only one of which was cost. Implications for state health insurance policies are discussed.