(Reuters Health) - Premium increases for Medicaid, the government health program for the poor, may leave many U.S. children uninsured, a new review suggests.
Higher premiums for the national Children’s Health Insurance Program (CHIP), which also provides coverage to low-income kids, may have a similar result.
“Premium requirements can represent a financial burden that competes with other necessities in the family budget like food or heating,” said lead study author Brendan Saloner of Johns Hopkins Bloomberg School of Public Health in Baltimore.
“When families face these difficult choices, some may decide to drop public insurance, and in some cases the child may then become uninsured,” Saloner added by email. “This can be problematic because we know that children that lack health insurance have worse access to care than those on Medicaid and CHIP, and sometimes do not receive recommended health services like vision care, vaccinations or mental health care.”
As of 2013, 30 states imposed premiums on some children in the CHIP program and five states imposed them on some Medicaid recipients. The fees ranged from about $10 to $39 per month.
To see how increases in these cost-sharing premiums impact coverage for kids, Saloner and colleagues analyzed data from 17 studies published between 1995 and 2014, and reported their findings February 19 in Pediatrics.
One study using national survey data from 1996 to 2003 estimated that raising premiums by about $10 in 2003 dollars would result in a 3 percentage point decrease in public insurance enrollment among children eligible for CHIP, with roughly one-third of these kids becoming uninsured.
Another study of medical expense survey data from 1999 to 2010 also estimated the impact of a $10 premium increase. The result was an average 3.9 percentage point decrease in public insurance enrollment for kids, countered by a 2.3 percentage point increase in coverage through private health plans – leaving a net rise in the child uninsured rate of 1.6 percentage points.
Only one study in the analysis looked at how premiums impact access to care, and found waiving these monthly payments in Idaho to be associated with higher odds that kids got well-child checkups.
In addition, just one study looked at whether premium increases can save government health programs money, and found these fees produce little revenue compared with average program costs.
Because the studies tracked the effects of premium increases in different ways, it is difficult to analyze trends across all of the earlier research, the authors caution. They also had little data on how premium changes impacted access to care.
Even so, the researchers conclude that higher fees may result in fewer children getting preventive care or other needed treatment.
“The lower a family’s income, the greater the challenge associated with paying a premium for a child’s coverage,” said Joan Alker, executive director for the Center for Children and Families at Georgetown University in Washington, D.C.
“Low-wage working families are struggling to keep food on the table and pay the rent so even a small premium can result in some very difficult choices,” Alker, who wasn’t involved in the study, added by email.
Even when children don’t become permanently uninsured, they may temporarily lose coverage when their parents fall behind in paying premiums, noted Judith Solomon, a vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C., who wasn’t involved in the study.
“What we call churn in coverage is a big problem – i.e. people losing and regaining coverage over relatively short periods of time,” Solomon said by email. “A great deal of churn occurs at the time renewals of coverage are due but non-payment of premiums can also cause churn.”
Churn can quickly contribute to health problems for kids, particularly if they have chronic problems like asthma or diabetes, said James Marton, an economics and health policy researcher at Georgia State University in Atlanta who wasn’t involved in the study.
“Children churning on and off public coverage are less likely to have a usual source of medical care and that can result in worse health outcomes, including a higher likelihood of preventable hospitalizations,” Marton said by email.