Coverage and Access to Care for Children with Chronic Health Conditions in the ACA

Gilbert Gonzales, MHAHealth Policy & ManagementUniversity of Minnesota

NRSA Trainees Research ConferenceSan Diego, CAJune 7, 2014

Coverage & Access to Care for Children with Chronic Health Conditions in the ACA

Click to edit Master title style

Click to edit Master text stylesSecond level

Third levelFourth level

Fifth level

Acknowledgments

Lynn A. BlewettMichel Boudreaux

State Health Access Data Assistance Center (SHADAC)Division of Health Policy & ManagementUniversity of Minnesota

2




Fifth level

Research Question

Did the ACA’s guaranteed issue requirement improve insurance coverage and access to care for children with pre-existing conditions?

3




Fifth level

Pre-Existing Conditions Prior to Health Reform

57 million people under 65 living with a pre-existing condition• Common health conditions including:

Cancer, heart disease, asthma, arthritis, hypertension, diabetes, HIV, obesity, high cholesterol, attention deficit hyperactivity disorder (ADHD), stress and adjustment disorders

17 million children living with a pre-existing condition

4

Source: Assistant Secretary for Planning and Evaluation (ASPE), 2011.




Fifth level

Pre-Existing Conditions Prior to Health ReformHealth Insurance Companies in Individual Market

1. Denied health insurance coverage, 2. Denied coverage for specific services,3. Increased premiums for people with pre-existing conditions.

19% of applicants in the individual market were denied enrollment in 2010.

Group health plans were prohibited from denying coverage to people with pre-existing conditions under federal law.

5

Source: Government Accountability Office (GAO), March 2011.




Fifth level

Coverage and Access to Care

6

50%

2%

41%

6% 6% 4%

95%

80%

55%

3%

32%

9%4% 2%

93%

76%With Chronic Conditions Without Chronic Conditions

Source: National Health Interview Survey, 2007-2010.




Fifth level

Pre-Existing Conditions Prior to Health ReformState law varied on guaranteed issue

5 states required insurers in the individual market to guarantee issue14 states provide partial protections for people with pre-existing conditions (e.g. meeting minimum score on health status questionnaire, insurer of last resort, high risk pool)Remaining states have no guaranteed issue provisions

7

Source: Kaiser Family Foundation, 2012.




Fifth level

Pre-Existing Conditions Under Health Reform

The Affordable Care ActAs of September 23, 2010, the ACA mandated guaranteed issue requirements for children under 19 years.

The law did not enforce community rating.• Families with chronically ill children potentially faced high premiums

that prevented them from obtaining coverage.

8




Fifth level

Data

National Health Interview Survey (NHIS), 2007-2012

Treatment Group:Children previously diagnosed with a chronic condition (n=10,909)

• Attention-deficit hyperactivity disorder (ADHD), mental retardation, Down syndrome, asthma, cerebral palsy, sickle cell anemia, muscular dystrophy, autism, congenital or other heart disease, and diabetes

Comparison Group:Children not diagnosed with a chronic condition (n=41,450)

9




Fifth level

Analysis

1. Pre-post changes in health insurance coverage• Dependent ESI, Individual, Public, Uninsured

2. Pre-post changes in access to care measures• Delayed care due to cost, Forgone care due to cost, Usual source of care,

Received well-child checkup

3. Difference-in-differences analysis• Controlled for race and ethnicity, age, sex, health status, citizenship, household

language, family income, parents’ highest educational attainment, parents’ work status, family structure, region and quarter of interview.

10




Fifth level

Analysis






11

Pre-Period: January 2007—September 2010Post-Period: October 2011—December 2012




Fifth level

Analysis






12

Separate models for infants and toddlers (0-3 years), young children (4-11 years), and adolescents (12-17 years)

Pre-Period: January 2007—September 2010Post-Period: October 2011—December 2012




Fifth level

Pre-Post Changes in Health Insurance(Percentage Point Changes)

Series1

-6.5%

-4.5%

-2.5%

-0.5%

1.5%

3.5%

5.5%

-5.2%

0.7%

6.0%

-1.6%

-2.6%

-1.0%

5.0%

-1.4%

With Chronic Conditions Without Chronic Conditions

13

Source: National Health Interview Survey, 2007-2012. * indicates p<0.05

*

*

*

*

*

Dependent ESI

Individual

Public

Uninsured




Fifth level

Adjusted Difference-in-Differences (in red)(Percentage Point Changes)

Series1

-6.5%

-4.5%

-2.5%

-0.5%

1.5%

3.5%

5.5%

-5.2%

0.7%

6.0%

-1.6%

-2.6%

-1.0%

5.0%

-1.4%


14

Adjusts for race and ethnicity, age, sex, health status, citizenship, household language, family income, parents’ highest educational attainment, parents’ work status, family structure, region and quarter of interview.


*

*

*

*

*

Dependent ESI

Individual

Public

Uninsured

-0.6 +1.9

-0.6

-0.4*




Fifth level

Pre-Post Changes in Access to Care(Percentage Point Changes)

Series1

-6.5%

-4.5%

-2.5%

-0.5%

1.5%

3.5%

5.5%

-4.6%

-2.6%

0.9%

3.0%

-1.4%-0.6%

1.9%

4.2%


15


*

*

*

*

*

Delayed Care Forgone Care

Usual Source of Care

Received Checkup




Fifth level

Adjusted Difference-in-Differences (in red)(Percentage Point Changes)

Series1

-6.5%

-4.5%

-2.5%

-0.5%

1.5%

3.5%

5.5%

-4.6%

-2.6%

0.9%

3.0%

-1.4%-0.6%

1.9%

4.2%


16

Adjusts for race and ethnicity, age, sex, health status, citizenship, household language, family income, parents’ highest educational attainment, parents’ work status, family structure, region and quarter of interview.


*

*

*

*

*

Delayed Care Forgone Care

Usual Source of Care

Received Checkup

-2.9 -1.8-1.1

-1.5

**




Fifth level

Conclusion

Adolescents (12-17 years) with chronic health conditions

Still taking up individual coverage and less likely to delay or forgo medical care due to cost after the ACA

Similar findings not found among infants, toddlers and young children

Results represent an early, lower-bound estimate

2010 mandate lacked a community rating provision

17




Fifth level

www.shadac.org@shadac

PhD CandidateGraduate Research Assistant

[email protected]

University of MinnesotaSchool of Public Health

Division of Health Policy & Management

Gilbert Gonzales, MHA

mailto:[email protected]

Coverage and Access to Care for Children with Chronic Health Conditions in the ACA

Health & Medicine

Transcript of Coverage and Access to Care for Children with Chronic Health Conditions in the ACA