What Happens to Children Who Lose Public Health Insurance Coverage?

Abstract

Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. While FHIAP-disenrolled children were more likely to have private health-insurance coverage than those leaving SCHIP, absolute levels were low (53 percent and 33 percent, respectively). Thus, these programs generally did not provide a bridge to nonsubsidized private health insurance. Despite higher incomes (the main reason for losing coverage), many families did not purchase private health insurance, presumably because they still could not afford to do so.

Factors influencing the decision to drop out of health insurance enrolment among urban slum dwellers in Ghana

“…An individual's health status and uncertainty about episodes of illness can significantly influence decisions on enrolment continuation or discontinuation (Mitchell et al . ). Expected utility theorists explain how individuals are risk‐averse, and that influences choices about insurance uptake (Schneider ; Gottret & Schieber ).…”

“…Individual predisposing factors are linked to the socio‐economic and demographic profile of the enrollee (Mitchell et al . ; Kamuzora & Gilson ; Sarpong et al . ; Jehu‐Appiah et al .…”

SCHIP Reconsidered

“…1 Enrollment remains complicated and unstable; according to one study, two-thirds of all children losing public insurance experience a break in coverage. 2 As of 2006, SCHIP's twelve-month continuous enrollment option was a feature of only sixteen state programs. 3 The reauthorization of SCHIP offers an opportunity to consider the program with a fresh eye and to view this modest program in the broader context of recent changes in Medicaid program structure and design and ongoing comprehensive state health reform efforts.…”