title: Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.
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.
authors.affiliation: Salam Abdus (salam.abdus@ahrq.hhs.gov) is a senior economist at Social and Scientific Systems, in Rockville, Maryland.
authors.forename: Salam
authors.initials: S
authors.lastname: Abdus
authors.affiliation: Julie Hudson is a senior economist in the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, at the Agency for Healthcare Research and Quality (AHRQ), in Rockville.
authors.forename: Julie
authors.initials: J
authors.lastname: Hudson
authors.affiliation: Steven C. Hill is a senior economist in the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, AHRQ.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Hill
authors.affiliation: Thomas M. Selden is director of the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, AHRQ.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Selden
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000706:statistics & numerical data; D002675:Child, Preschool; D065326:Children's Health Insurance Program / Q000191:economics* / Q000706:statistics & numerical data; D005191:Family Characteristics; D019538:Health Care Surveys; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D007341:Insurance / Q000191:economics*; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured; D011203:Poverty; D014481:United States
keywords: Children < Insurance; Insurance Coverage < Insurance; Medicaid