Low-income children with chronic conditions at risk for significant costs without CHIP renewal
Low-income children with chronic conditions and their families could experience drastic cost increases for health care — as much as $233 to $2,472 in annual expenditures, depending on income levels and individual needs — if the Children’s Health Insurance Program is not renewed and the families are switched to Marketplace health insurance plans.
“Prior evaluations have suggested that Marketplace plans overall offer less generous protections against high out-of-pocket expenses when compared to [Children’s Health Insurance Program (CHIP)] plans,” Alon Peltz, MD, MBA, a postdoctoral fellow at the Yale School of Medicine, and colleagues wrote. “In 2015, the secretary of health and human services, in conducting a statutorily required review of Marketplace plans for children’s coverage, declared that they were not comparable to CHIP plans in providing coverage for children’s services.”
Peltz and colleagues noted that “these limitations … could also be particularly problematic for families of children with certain chronic health conditions who might need specialized services not routinely covered by Marketplace plans as essential health benefits, or who might experience episodic or continuously elevated need for services.”
To examine the two current policy alternatives to CHIP (extending federal funding for the program or enrolling children in health insurance Marketplace plans), the researchers used detailed health plan data to simulate and compare out-of-pocket expenses for children with chronic conditions. Categories were created at four levels, aligning with percentage categories of the federal poverty level.
The six most common pediatric chronic conditions included asthma, attention-deficit/hyperactivity disorder (ADHD), developmental disorders and autism, diabetes, epilepsy and mood disorders, including anxiety and major depressive disorder. Children with these six disorders and conditions made up two-thirds of all children with a chronic condition that needed treatment.
For these children of low-income families, their out-of-pocket expenses would increase $233 at the lowest income level to $2,472 at the highest (251%-400% of poverty). Data demonstrated that families with children who had epilepsy, diabetes or mood disorders may experience the highest out-of-pocket costs for treatment due to an increase in cost sharing for prescription drugs (25% of the difference) and hospitalizations (23% of the difference).
“The results of our study point to several strategies that policy makers might consider to enhance the financial protections offered by Marketplace plans for children — in particular, children in families with incomes above 200% of poverty,” Peltz and colleagues wrote. “However, these strategies presume a robust health insurance Marketplace and small modifications to the [Affordable Care Act (ACT)]. Given concerns about the viability of the Marketplace, the legal battles regarding the cost-sharing reduction payments, and the efforts to repeal the ACA, reauthorizing funding for CHIP is most likely the least disruptive strategy moving forward.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures or conflicts of interest.