By Joe Touschner
A new study from the Government Accountability Office (GAO) takes an initial look at how CHIP compares to private health coverage for children. It examined benefits, costs, and access to care in CHIP and made some preliminary comparisons to health plans similar to those offered in marketplaces. GAO found that CHIP is considerably more affordable for families than private plans, while providing similar benefits and access to care.
GAO’s study is a preview of what’s to come—the ACA charges the Secretary of HHS with evaluating by April 2015 whether CHIP’s benefits and cost-sharing are comparable to those in qualified health plans (QHPs) in every state. But in taking a look now, the GAO did not have the luxury of complete information on qualified health plans. So the study is limited in a few ways. First, GAO analysts examined only five selected states, Colorado, Illinois, Kansas, New York, and Utah. They had a solid basis for comparing benefits because QHP benefits are based on a benchmark plan that is already known for each state. But the cost-sharing for QHPs is not based on the same benchmark plans and has only recently been made public—not in time for GAO’s analysis.
Still, GAO sought to draw comparisons where possible. It looked at a range of more than 30 benefits and found that they were generally comparable between the CHIP plan and the plan that serves as the EHB benchmark in each of the five states. Where they found differences, CHIP sometimes provides greater benefits than the benchmark plans, depending on the state and particular benefit. For instance, Kansas’s CHIP plan covered hearing services while its benchmark plan did not. And CHIP plans generally had fewer limits on home and community based services than benchmark plans.
Comparing cost-sharing is a bit more tricky not only because there is no “benchmark” for QHP cost-sharing levels. Cost-sharing can also vary based on families’ income both in CHIP and in QHPs. Still, to the extent it could make comparisons, GAO found CHIP to be more affordable for families.
Because CHIP’s benefits and cost-sharing will need to be closely examined not just for the five states GAO selected, CCF and the National Academy for State Health Policy have been collaborating to produce a summary of benefits and cost-sharing for all of the separate CHIP programs across the country. Look for that in the next couple of months.
And look for more on the GAO study even sooner right here on Say Ahhh!—a coming post will highlight GAO’s access to care assessment. The agency performed a sophisticated analysis to separate access measures in CHIP versus Medicaid, giving us one of the first looks at access in CHIP not combined with other public coverage.
