Health Coverage for Children: Where do we stand?

Joan Alker/Sabrina CorletteGeorgetown Health Policy Institute

February 4, 2014

2Source: Georgetown University Center for Children and Families analysis of estimates from the US Census Bureau’s 2011 American Community Survey. Source: Georgetown University Center for Children and Families analysis of estimates from the US Census Bureau’s 2011 American Community Survey. Note: Coverage sources are not mutually exclusive. Children may have more than one source of coverage.

Children = 72.8 million Medicaid &

CHIP; 36.50%

Other Pub-lic; 0.60%

Employer; 51.90%

Individual Market; 7.20%

Uninsured, 7.50%

How Children Are Covered, 2011

66.2% of Low-income children are on Medicaid/CHIP

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Children’s Coverage Under the ACA

Source: Urban Institute’s Health Insurance Policy Simulation Model, 2011. “Improving Coverage for Children Under Health Reform Will Require Maintaining Current Eligibility Standards for Medicaid and CHIP”, Health Affairs, 30, no. 12 (2011)

Employer50%

Individual3%

Medicaid & CHIP41%

Other Public1%

Uninsured5%

An estimated two million children will have individual market exchange coverage

SOURCES: State decisions on the Medicaid expansion as of October 21, 2013. Based on data from the Centers for Medicare and Medicaid, Kaiser Family Foundation and state legislative scan by Georgetown CCF.

Status of Medicaid Expansions(1/1/31)

WY

WI

WV

WA

VA

VT

UT

TX

TN

SD

SC

RI PA

OR

OK

OH

ND

NC

NY

NM

NJ

NH

NV NE

MT

MO

MS

MN

MI1

MA

MD

ME

LA

KY KS

IA IN IL

ID

HI

GA

FL

DC

DE

CT

CO CA

ARAZ

AK

AL

Moving Forward at this Time (26 States including DC)Not Moving Forward at this Time (20 States)Ongoing Discussion (5 States)

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States with Extended Waivers (2 States)

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Open Enrollment: Mid-Way Point

• Rates lower than projected vs. “rate shock”• Early renewals and policy cancellations• Rocky websites• Back end glitches• SBMs outperforming FFMs• Coverage gaps• Provider network issues

Open Enrollment: Mid Way Point

Continued lack of awareness

Where are the Uninsured?

7 in 10 uninsured adults have not yet been to marketplace

69% do not know financial help is available

Main reason uninsured?“I can’t afford it.” 69%

81% do NOT know about March deadline

Uninsured adults in 30s less likely to know about options than other age cohorts

Source: Enroll America, Results from a National Survey of Uninsured Adults 18 to 64Conducted Dec. 12-22, 2013; KFF January 2014 tracking poll

47% have unfavorable view24% have favorable view

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Open Enrollment: Mid-Way PointEnrollment Status

o Web Site and Call Center Activityo 53.2M visits to websiteso 11.3M calls to call centers

o Eligibility Determinations and Plan Selectiono 3 M have selected planoPublic program data is not yet very useful

Source: Assistant Secretary for Planning & Evaluation, HHSMonthly status report October 1-Dec. 28, 2013 and Centers for Medicare and Medicaid Services

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Open Enrollment: Mid-Way PointEnrollment Status

• Breakdown: Gender– 46% Male– 54% Female

• Breakdown: Age– 6% < 18– 24% between 18-

34– 55% between 45-

64

o Breakdown: Popular Planso 20% Bronzeo 60% Silvero 13% Goldo 7% Platinumo 1% Catastrophic

o Breakdown: Subsidieso 79% receiving

subsidies

Source: Assistant Secretary for Planning & Evaluation, HHSMonthly status report October 1-Dec. 28, 2013

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ACA Marketplaces: Policy Issues to Watch

• Cost-sharing• Benefits• Employer-

based coverage

• Enrollment• Premiums• Narrow

networks• Provider

capacity

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ACA Marketplaces: Issues for Families

• Coverage problems

• Use of services• Churn• Reconciliation

• E&E Assistance• Health

insurance literacy

• Appeals

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Children’s Coverage in the United States, 2014

28% of separate CHIP kids moving to Medicaid

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National Eligibility Levels, 2013

Potential Coverage

Gap

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Premium cost for:

Income of:

Self-only

Household

> 9.5%

Subsidies for an employee with an ESI

coverage offerAre available only if:

Affordability Test - Individual

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Premium cost for:

Income of:

Self-only

Household

> 9.5%

Subsidies for a family with an ESI coverage

offerAre available only if:

Affordability Test – Family Glitch

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Premium cost for:

Income of:

Household

Household

> 9.5%

Subsidies for a family with an ESI coverage

offerAre available only if:

Affordability Test – Preferred Outcome

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FUTURE OF CHIP?

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CHIP Funded through 2015o Maintenance of Effort through 2019o Family glitch and other glitches underscore

the need for CHIP to continueo Future Key question – How will marketplace

coverage work for kids?o Recent GAO study was limited in scope – found

benefits similar but not cost-sharingo CMS comparability study later this year?o CCF/NASHP benefits study coming soon but

much more work is needed

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Future of CHIP: State Directions?

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Future of CHIPo Arkansas approach – using Medicaid/CHIP to buy

marketplace coverageo Cost effective??o Will kids get the same benefits?o Family together? o Access to providers?

o Arizona – world with no MOE – kids in exchangeo Family glitch, enrollment glitcheso Benefits/cost-sharing

o California - CHIP is a financing source for Medicaid

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For More Informationo Joan Alker:

o jca25@georgetown.eduo ccf.georgetown.eduowww.theccfblog.org/

o Sabrina Corletteo sc732@georgetown.eduo chir.georgetown.eduowww.chirblog.org/