Parents Value Affordability and Benefits (not whole-family plans) in Children’s Coverage

Last week our colleagues at the Kaiser Commission on Medicaid and the Uninsured released a new report that children’s advocates, in particular, will find helpful, if not surprising. Helpful because it allows us to hear directly from parents about their children’s coverage experiences and what they value most. Kaiser’s research team conducted 14 focus groups of parents in six cities whose children were covered by CHIP, employer-sponsored coverage, or Marketplace coverage. In short, their focus groups found that parents value 1) affordability and 2) broad benefits above all in their children’s coverage.

We had several takeaways from this helpful work, which reinforces the continued case for keeping CHIP strong for the foreseeable future (beyond 2019 from our perch):

Parents in these focus groups are reinforcing what the research has made clear: CHIP coverage is more affordable for families. Those whose children received CHIP coverage reported the most security in the affordability of needed services and the predictability of costs. In contrast, parents with employer-sponsored insurance thought costs were more expensive—some citing very high deductible plans. Parents whose children receive Marketplace coverage were mixed on affordability.

Parents generally didn’t see access to care as a problem, regardless of coverage type, though some parents had challenges with specialists. Again, the parents reflect what research says: Any challenges in getting needed care were not limited to one coverage type or program. Generally, parents with both CHIP and private coverage were satisfied with access, especially to primary care, though some noted challenges with the hours and locations of specialists.

Parents would keep children in separate health plans—especially CHIP—if it means they will pay less for their care. One of the central questions around CHIP’s future has been whether the program remains necessary now that we have marketplace coverage available for families at many CHIP income eligibility levels. Some asked: wouldn’t parents want their children in the same plans as the rest of the family? In theory, this seems logical but assumes that same-plan coverage is a high priority relative to other factors. These focus groups asked what parents value most in coverage for their children—same-family coverage did not emerge in their answers. Parents had to be probed about this. And when asked directly, while they saw possible advantages, many said they would do more paperwork and take on additional hassles straddling multiple plans if it meant they would pay less. And, of course, see above: CHIP is more affordable.

Parents worried what it would mean for them financially if CHIP were no longer available. As my colleague Carrie Fitzgerald of First Focus also expressed, the quotes and stories from this report make this read worth your time. This is especially true when you read the struggles they feel to keep themselves economically secure. For example:

“For me, personally, just to be quite honest, it would be a financial disaster. …Chances are real good I would be looking for a good bankruptcy attorney.” – Alabama parent of a child with CHIP (p. 11)

And while many CHIP parents reported they would try to add their children to their own coverage if CHIP ended, they worried about the added costs, wondering if they may even have to delay or forego care for their children or sacrifice in other ways to make ends meet: cutting back on food, clothing, school activities and sports, or working additional jobs. Our research in Arizona last year listening to parents whose children lost KidsCare (AZ’s CHIP program, which is now inactive) tells us that the concerns of the parents in this study are well-placed—many experienced higher costs and less comprehensive benefits for their children when their KidsCare ended. These economic concerns extended beyond CHIP parents—parents with private coverage also expressed a desire to keep CHIP available in case their coverage or financial circumstances changed. Our research in Arizona last year listening to parents whose children lost KidsCare (AZ’s CHIP program, which is now inactive) tells us that the concerns among parents in this study are well-placed—many experienced stress from higher costs and more limited benefits for their children when their KidsCare ended.

We have the research (see here, here and here for just a few) and now we have parents’ perspectives. For me, the takeaways from both are clear: CHIP needs to remain a strong part of the coverage system for kids as the hard work continues to make Marketplace and other private coverage affordable for families and of high quality for kids.