AHRQ Studies in Health Affairs Examine Child Health Coverage, Medicaid Readmissions, Bundled Payments

AHRQ-funded studies appearing in the August 4 issue of Health Affairsexamine an array of health care issues. Open-access abstracts for the studies are available online. The study, “Children's Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children" shows how the relationship between premiums and coverage varies considerably by income level and parental access to employer-sponsored insurance. Another study,“Medicaid Admissions and Readmissions: Understanding the Prevalence, Payments, and Most Common Diagnoses,” found that Medicaid readmissions in 19 states were widespread (averaging 9.4 percent of all admissions), costly ($77 million per state) and represented 12.5 percent of Medicaid payments for all hospitalizations. A third study,“Bundled Payment Fails To Gain a Foothold in California: The Experience of the IHA Bundled Payment Demonstration,” found that the pilot on bundled payment for orthopedic procedures drew few participants due to factors such as administrative burden, state regulatory uncertainty and disagreements about bundle definition.

VOL. 33| NO. 8August 2014Variety Issue

1. 

1. Alert me to new issues of Health Affairs

• From The Editor-In-Chief
• Entry Point: New Success Metrics
• Safety-Net Hospitals And ACA Payments
• Obstetric Complication Rates
• Bundled Payments Fail In California
• Premiums' Impact On CHIP Enrollment
• US Black-White Life Expectancy Gap
• Diabetic Amputations By Income
• Showing MRI Prices Caused Competition
• Health Spending Growth And Recession
• US Behavioral Health Care Data
• PDUFA And Black Box Warnings
• US Tobacco Users And Health Coverage

Children’s Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children

Children’s Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children

1. Salam Abdus1,*, 
2. Julie Hudson2, 
3. Steven C. Hill3 and 
4. Thomas M. Selden4

+Author Affiliations

1. ¹Salam Abdus (salam.abdus@ahrq.hhs.gov) is a senior economist at Social and Scientific Systems, in Rockville, Maryland.
2. ²Julie Hudson is a senior economist in the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, at the Agency for Healthcare Research and Quality (AHRQ), in Rockville.
3. ³Steven C. Hill is a senior economist in the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, AHRQ.
4. ⁴Thomas M. Selden is director of the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, AHRQ.

1. ↵*Corresponding author

Abstract

Both Medicaid and the Children’s Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999–2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. In this income range, the increase in uninsurance may be higher among those children whose parents lack an offer of employer-sponsored insurance than among those whose parents have such an offer. Among children with family incomes of 101–150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance. In this income range, the increase in uninsurance is even larger among children whose parents lack offers of employer coverage.