Many children are going without coverage needlessly
Many children are going without coverage needlessly
Children with private health insurance are more than six and a half times as likely to lose coverage in the three months after one or both of their parents loses a job, compared to children whose parents remain employed, according to researchers from the Child Policy Research Center at Cincinnati (OH) Children's Hospital Medical Center. Their study, The Impact Of Parental Job Loss On Children's Health Insurance Coverage, published in the July 2010 Health Affairs, says that for every 1,000 jobs lost, 311 privately insured children lose health insurance coverage. The poorest and most vulnerable privately insured children were especially likely to lose coverage.
Gerry Fairbrother, PhD, the study's lead author and associate director of the Child Policy Research Center, wasn't surprised by the findings. "I expected it would be the case, but the first time it's been shown nationally with a high-quality database," she says.
Dr. Fairbrother says that since the children were privately insured, it's possible that at least some of their families might not have had previous contact with the public assistance system. Therefore, they might have been unaware their children were eligible for coverage.
She says that state Medicaid programs should look at ways to provide more aggressive outreach if they know a plant is closing, and provide additional public service announcements about availability of public coverage and eligibility requirements.
While privately insured children lost coverage when a parent lost a job, publicly insured children lost coverage at fairly high rates regardless of whether there was a job loss. This was not surprising either, says Dr. Fairbrother.
"This is due to high rates of churning in public insurance, which is not tied to employment, but is tied to income," says Dr. Fairbrother. "That high level persists whether or not parents lose a job."
Dr. Fairbrother says that it is not a foregone conclusion that the problem of children losing coverage, whether they are privately or publicly insured, is going to be solved under health reform. "Whoever administers the [health information] exchanges (HIEs) will have to be aggressive in making sure people don't fall off the rolls," she says.
If a parent in the HIEs loses a job, it could be that the family becomes eligible for Medicaid. "There would be an issue of getting that word out and making sure members of the family remained covered," says Dr. Fairbrother. "If we need education now, we are certainly going to need it under health reform, which brings in a new set of complexities."
More outreach needed
"Since employer-based insurance is the most prevalent form of coverage in this country, it's no surprise that children lose coverage when a parent loses a job," says Tricia Brooks, a senior fellow at the Georgetown University Center for Children and Families in Washington, DC. "Unemployed parents simply can't afford COBRA coverage, and many of these families have never used public insurance programs."
Even though large majorities of people know Medicaid and the Children's Health Insurance Program exist, there is confusion about who is eligible and how to apply. "Like sales, marketing and customer service in business, outreach and application assistance for public coverage programs [is] needed on a continual basis to ensure that eligible individuals and families get enrolled and stay enrolled," says Ms. Brooks.
Ms. Brooks notes that a number of states deploy rapid response teams when major employers close down. Counseling and education is provided to help displaced workers access training, seek new work, and apply for other public assistance.
Workers who lose employment under other circumstances don't necessarily get that level of personalized assistance, however. "Many could be reached through unemployment offices and one-stop job centers," says Ms. Brooks. "Providing information, as many of these centers and agencies do, is a start. More deliberate outreach and application assistance is better."
Unfortunately, families and individuals need the most help during downturns in the economy, which restricts state budgets. Resources for administration of public programs are scarce, and agencies have to do more with less.
"State financial support for outreach and application assistance is hard to come by," says Ms. Brooks. "We need to institutionalize the role of outreach and application assistance, and boost it in times of high need."
Streamlining the application process can remove barriers to enrollment, such as minimizing the paperwork that is required. "These actions not only improve enrollment, but also increase administrative efficiency," says Ms. Brooks. "This allows states to dedicate more resources to health care services."
Contact Ms. Brooks at (202) 365-9148 or [email protected] and Dr. Fairbrother at (513) 636-0189 or [email protected].
Children with private health insurance are more than six and a half times as likely to lose coverage in the three months after one or both of their parents loses a job, compared to children whose parents remain employed, according to researchers from the Child Policy Research Center at Cincinnati (OH) Children's Hospital Medical Center.Subscribe Now for Access
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