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Children's health insurance program premiums adversely affect enrollment, especially among lower-income children
Salam Abdus1, Julie Hudson2, Steven C Hill3
1Salam Abdus (salam.abdus@ahrq.hhs.gov) is a senior economist at Social and Scientific Systems, in Rockville, Maryland.
Insights
Children
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Medicaid and the Children's Health Insurance Program (CHIP) provide crucial health coverage for low-income children.
- Many states implement premiums for CHIP and Medicaid coverage across various income levels.
- Understanding the impact of these premiums on insurance coverage and uninsurance is vital for public health policy.
Purpose of the Study:
- To analyze the association between premium costs in Medicaid and CHIP and insurance coverage rates.
- To investigate how this association varies based on family income and parental access to employer-sponsored insurance.
- To quantify the impact of premium increases on children's uninsurance rates.
Main Methods:
- Utilized data from the Medical Expenditure Panel Surveys spanning 1999-2010.
- Employed regression analysis to examine the relationship between monthly premium costs and coverage status.
- Stratified analyses by family income relative to the federal poverty level and parental employment-based insurance offers.
Main Results:
- A $10 increase in monthly premiums correlated with a 1.6% reduction in coverage for children above 150% federal poverty level.
- For children at 101-150% federal poverty level, a $10 premium increase led to a 6.7% coverage reduction and a 3.3% increase in uninsurance.
- Children with parents lacking employer-sponsored insurance offers experienced larger increases in uninsurance due to premium increases.
Conclusions:
- Medicaid and CHIP premiums significantly impact insurance coverage and uninsurance rates, particularly for lower-income families.
- The effect of premiums is exacerbated for children whose parents do not have access to employer-sponsored health insurance.
- Policy considerations regarding premium levels should account for income and parental employment status to mitigate adverse effects on children's health coverage.
Abstract:
Both Medicaid and the Children's Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999-2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. In this income range, the increase in uninsurance may be higher among those children whose parents lack an offer of employer-sponsored insurance than among those whose parents have such an offer. Among children with family incomes of 101-150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance. In this income range, the increase in uninsurance is even larger among children whose parents lack offers of employer coverage.
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