View Research by Author - Jennifer Pelletier

Citation URL: http://www.urban.org/JenniferPelletier

This report uses the 2005 Kaiser Low-Income Coverage and Access Survey to examine low-income parents' perceptions of access and quality of care for the uninsured. The findings indicate that most low-income parents perceive that the uninsured do not have access to affordable medical and dental care and that the quality of care they receive is lower than for the insured. Low-income parents also have generally positive perceptions of Medicaid, indicating that efforts to increase eligibility and enrollment in Medicaid such as those included in current health care reform proposals would reduce uninsurance among this population.

Findings from interviews with low-income parents, part of the Robert Wood Johnson Foundation's Covering Kids & Families Evaluation, indicate that parental concerns about access to and quality of care under Medicaid/SCHIP do not reduce enrollment of eligible children in these programs. The positive feedback on the programs from parents of enrolled children—and the strong desire of almost all parents of uninsured children to enroll their children—attest to the success that states have had in publicizing their public health insurance programs and addressing concerns associated with them. However, administrative barriers often serve as a deterrent to enrollment and renewal.

With the reauthorization of the State Children’s Health Insurance Program (SCHIP) under consideration in early 2009, an important question is the extent to which uninsured children could be covered under employer-sponsored insurance (ESI) through premium assistance programs. Only 440,000 uninsured children who are eligible for Medicaid or SCHIP have at least one parent with ESI coverage. Since many more uninsured children are eligible for public programs than have access to ESI through their parents, policies to increase enrollment and retention in Medicaid and SCHIP have much greater potential than premium assistance programs to close coverage gaps among children.

As the reauthorization of the State Children's Health Insurance Program (SCHIP) and broader health care reform efforts are considered, important policy questions include where eligibility thresholds should be set for public coverage and how much latitude states should have in setting their thresholds. This analysis shows that employer-sponsored insurance premiums are less affordable for families at 300 percent of the FPL now than they were for families at 200 percent of the FPL in 1996, particularly in areas with a high cost of living and suggests the need to adjust eligibility thresholds for growth in health care costs.

State buy-in programs are designed to address coverage shortfalls among moderate- and higher-income children whose families are not eligible for Medicaid or SCHIP but who cannot afford, or do not have access to, private coverage. These programs allow families to buy their children into a comprehensive public insurance plan with low out-of-pocket cost sharing at an unsubsidized premium. As more states aim to achieve universal coverage for children, buy-in programs may be one component they consider in their plans to reach that goal. This brief explores some issues for states to consider before implementing a buy-in program.

This brief is the latest in a series using data from the 2005 Kaiser Low-Income Coverage and Access Survey to examine health coverage, access, and financial burdens associated with health care for young adults ages 19 to 29 in low-income families. The findings demonstrate that many low-income uninsured young adults experience problems gaining access to needed health care, with adverse consequences for both their health and financial well-being.

The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers. By examining access to paid sick leave and paid vacation using the 2003-2004 Medical Expenditure Panel Survey, the authors find that low-income families are less likely to have access to paid leave, especially if the family lacks a full-time/full-year worker. Among children whose parents have access to paid sick leave, parents are more likely to take time away from work to care for themselves or others.

This brief examines the dental access problems experienced by adults ages 19 to 64 in families with incomes at or below 200 percent of the Federal Poverty Level (FPL) using the 2005 Kaiser Low-Income Coverage and Access Survey. This report finds that both dental coverage and access to care are limited for low-income adults and that even low-income adults with dental coverage are not getting sufficient levels of needed dental care.

In July 2007, bills to reauthorize the State Children's Health Insurance Program were passed in both the House and the Senate. One question that has been raised is how well the bills target low-income children. In this brief, Genevieve Kenney and colleagues estimate that the proportion of children below 200 percent of the Federal Poverty Level (FPL) covered by the bills is 70% or higher. The share of uninsured children below 200 percent of the FPL who would gain coverage is estimated to be even higher (78 to 85 percent).

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