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February 23, 2016

CHOP study: Medicaid, CHIP beat out private insurance in helping low-income children

Children with public insurance have more preventive visits, fewer out-of-pocket costs

Are public insurance programs like Medicaid and CHIP as good for low-income kids as private insurance? One recent study from the Children's Hospital of Philadelphia says no: in many ways, they're better.

Children who are covered under Medicaid or the Children's Health Insurance Program (CHIP) pay fewer out-of-pocket costs and get more preventive care than privately insured kids, according to a study published last month in JAMA Pediatrics.

With CHIP's federal funding set to expire in a year, the study could provide critical information to Congress as it decides whether to renew the program or just rely on subsidies from the Affordable Care Act instead.

"We expected that perhaps Medicaid and CHIP would do as well as private insurance," said study co-author Amanda Kreider, who helped conduct the study at CHOP's PolicyLab. "But the fact that they did better...was surprising."

Researchers from the University of Pennsylvania and Johns Hopkins University worked together at the PolicyLab to analyze data on more than 80,000 children who participated in national health care surveys in 2003, 2007 and 2011/12. They then extrapolated their data to the entire population. 

All the kids lived either at the federal poverty level or up to three times that level. For these children, living nearly in poverty, public insurance came out ahead of private plans.

Seventy-eight percent of Medicaid/CHIP users said that insurance always meets their child's needs, as opposed to 73 percent of private insurance users. Eighty-eight percent of kids covered under public insurance had at least one preventive checkup at the doctor's office in a year, compared to 83 percent of privately insured kids. These results were all statistically significant.

"The big takeaway for us: We found that kids [who] were enrolled in public insurance...had really good access to preventative medical and dental care," said Kreider.

She suspects that public insurance got better results for preventive care because the law requires those plans to cover more than private insurance.

Families with private insurance are also three times more likely than Medicaid families to pay out-of-pocket costs. Seventy-seven percent of privately insured children and 38 percent of children on CHIP, but only 26 percent of children on Medicaid, had to pony up for extra expenses.

Specialty care proved the biggest obstacle for young kids, no matter what kind of insurance they had. Twenty-two percent of privately insured kids had problems seeing a specialist, compared to 23 percent for Medicaid and 28 percent for CHIP. If the child had a chronic or pre-existing condition, those numbers went up to 29 percent, 20 percent and 25 percent, respectively.

Thankfully, it was very rare for children who were insured to have unmet medical needs. Only 2 to 3 percent had unmet needs, compared to 10 percent of uninsured kids.

The data all dates back to before the Affordable Care Act, aka Obamacare, took effect. But even though that law offers subsidies for private insurance, a loophole known as the "family glitch" means that many children still rely on CHIP or Medicaid.

Low-income people cannot qualify for government subsidies if their employer offers affordable health insurance, but the law only considers whether parents can afford the insurance for themselves, not for their whole family. A report from the left-leaning Urban Institute estimated that 1.1 million kids would lose insurance if CHIP wasn't renewed.

"It's really important for us not to be too hasty in discounting the value of our nation's public insurance for kids," said Kreider. "Our studies suggest that they're working really well."

Read the study here.

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