Health Insurance and Children s Well-Being Thomas DeLeire University of Wisconsin-Madison Presentation at the IRP Child Health and Well-Being Conference, October 12, 2010 1
What Do We Know? What Do We Need to Know? 2
The Percentage of Children with No Health Insurance: 1997-2009 (NHIS) 16 14 12 10 8 6 4 2 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 3
The Percentage of Children with Public and Private Insurance: 1997-2009 80 40 75 35 70 Private Public 30 65 25 60 20 55 15 50 10 45 5 40 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 0 4
What was the Health Impact of this Increase in Public Coverage? 5
Health Insurance and Health Many studies show that having health insurance increases utilization and expenditure Does health insurance improve health? RAND HIE: little health benefit Some studies find a health benefit of having insurance (e.g., Doyle 2005, Card et al., 2008) 6
Medicaid and Child Health Mixed evidence Currie and Gruber (1996) find improvements in prenatal care and infant mortality, but only for expansions targeted towards poor populations Other studies find no improvements in health (Piper et al., 1990; Kaester et al. 1999; Dubay et al, 2000) 7
Trends in child health 14 12 10 8 6 4 2 0 16 14 12 10 8 6 4 2 0 Percentage of Live Births with No Prenatal Care 1990 2000 2006 Percentage of Live Births that are Low Birth Weight 1990 2000 2006 White Black Hispanic White Black Hispanic 25 20 15 10 5 0 16 14 12 10 8 6 4 2 0 Percentage of Women who Smoke During Pregnancy 1990 2000 2006 Infant Deaths / 1000 Live Births 1995 2000 2005 White Black Hispanic White Black Hispanic 8
Wisconsin s Recent Experience: BadgerCare Plus 9
All Kids Eligible are for Coverage in Wisconsin
Enrollment: Children 400,000 Enrollment: Kids 300,000 200,000 100,000 0 Jan '07 Feb '07 Mar '07 Apr '07 May '07 Jun '07 Jul '07 Aug '07 Sep '07 Oct '07 Nov '07 Dec '07 Jan '08 Feb '08 Mar '08 Apr '08 May '08 Jun '08 Jul '08 Aug '08 Sep '08
Child Enrollment by FPL Dec-07 Sep-08 Change % of Change All 287,496 379,819 92,323 100% < 150 270,000 327,372 57,372 62% 150-200 17,400 37,447 20,047 22% 200-300 75 12,480 12,405 13% 300+ 21 2,520 2,499 3%
What Do We Need To Know? 13
How can we enroll more eligible children? Many eligible children do not enroll Early enrollment may improve health (Aizer, 2007) How can we enroll eligible children? Information and administrative costs are barriers to enrollment WI experience shows that automatic enrollment procedures can be effective and target efficient 14
How can we improve access to care? Access to care under Medicaid comparable to low-income privately insured (Coughlin et al., 2005) concerns for dental and specialty care Reimbursement rates can be low About 50% of private rates (Holahan, 1991) Increased fees may improve access and health (Currie et al., 1995) 15
Can We Reduced the Burden of Underinsured Children? Even children with good private insurance can face gaps in coverage Medicaid may provide better coverage than private insurance for many children with disabilities or chronic illness (Kaiser, 2010) 16
Co-insurance OOP Max A Deductible Slope =.20 Slope =.15 B 250 500 3000 5000 Total spending
Median OOP Spending ($) 3500 3000 2500 2000 1500 1000 500 0 Median OOP vs. Total Spending, Unadjusted Estimates Non-chronic Chronic 0 2500 5000 7500 10000 12500 15000 17500 20000 22500 25000 27500 30000 32500 35000 37500 40000 42500 45000 47500 Insurance curves illustrate significantly higher OOP spending among chronic relative to non-chronic for total spending amounts in excess of $8000 per year.
Financial Well-Being How well does Medicaid protect families against financial difficulties? Families with disabled children Medicaid Home and Community-Based Services Waivers (for children with disabilities or high medical needs) Waives the family income test Low enrollment caps (long waiting lists) 19
Current Policy Issues Should we be increasing coverage? ACA spend lots of money subsidizing the healthy uninsured to buy insurance Should we spend money in a more targeted fashion? Increase enrollment and improve access to care for poor children Provide services to a greater number of disabled children 20