Children’s Coverage: What Matters Most to Parents Results from Focus Groups in 6 Cities

The Children’s Health Insurance Program (CHIP) was enacted in 1997 to provide affordable coverage to low-income uninsured children who lived in families with incomes above the eligibility limits for Medicaid, but unable to afford private coverage. Medicaid and CHIP have helped to significantly reduce the number of low-income uninsured children nationally by expanding eligibility levels and simplifying enrollment procedures. CHIP now covers nearly 6 million children, building on Medicaid’s coverage of 28 million children.¹

The passage of the Affordable Care Act (ACA) as well as debate about extending funding for CHIP has meant that policy makers are considering options for the future of children’s coverage. Congress has extended funding for CHIP for two years (through 2017), but longer-term there will be additional debate about how best to ensure coverage to children in low and moderate income families. Specifically, would private coverage (either employer sponsored coverage or Marketplace) or Medicaid work for children who currently are enrolled in CHIP? To help inform policy makers about what matters most to parents with regard to children’s coverage, the Kaiser Family Foundation contracted with John Snow Incorporated (JSI) to conduct focus groups with parents with moderate incomes enrolled in private coverage who had children in public (primarily CHIP) or children with private coverage (generally the same coverage as the parent). Key findings include the following:

• Affordability was a primary concern for parents with moderate incomes who are struggling financially despite recent improvements in the overall economy. Parents thought the cost of private coverage for their children was too high and often unpredictable but CHIP coverage was affordable.
• Across private and CHIP coverage, families valued comprehensive benefits and were generally satisfied with providers available through their coverage; however, parents in both groups said they had some problems accessing selected specialists. Parents reported that children with private coverage and CHIP had access to vision and dental coverage and that these services were highly valued.
• When asked about their own private coverage, parents reported that the costs of coverage were high and they frequently delayed or avoided seeking care because of costs. Parents reported high (up to $10,000) deductibles and high out of pocket costs for copayments or coinsurance. In addition, parents reported gaps in coverage and periods when they were uninsured when they were in between jobs.
• Coverage under the same plan as their children was not a priority for parents. Parents with children in private coverage were willing to have children in a separate plan for lower costs. Parents with children in CHIP did not want children in private coverage (generally due to costs).
• Parents were largely unaware that a debate had been going-on in Congress. Parents of children with CHIP as well as parents of children with private coverage were worried about the future of CHIP noting that the program provided a role as a safety-net for those who need it. Nearly all parents with children enrolled in CHIP as well as those with children who had private coverage said they would enroll in Medicaid if their current coverage were no longer available. Parents with CHIP coverage said there would be serious financial consequences for their families if CHIP were no longer available and they had to enroll their children in private coverage.