Health Coverage Issues of Children in Houston

Christopher M. Born Texas Children’s Health Plan

February 1, 2007

Presentation to:

CHIP Coalition – Legislative Staff Briefing

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Robert Haas, Chairman and CEO Levi Strauss & Co

“it used to be that what happened to your employees when they went home at the end of the day was their business. But today’s worker’s sick child is YOUR business, because if she’s worrying about her child or calling in sick when she isn’t – and probably feeling resentful because she had to lie – she isn’t going to be productive…..

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The Impact of Uninsured Children

They consume healthcare anyway– Physicians– ER’s and hospitals– Clinics

They pay cash…but not much– A significant part of bad debt– Cost shifting to commercial insurers– At what price? – the issue of transparency

Early treatment is efficacious– An ounce of prevention…

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Agenda

Research on children’s health coverage Research on effects of continuous eligibility

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Children’s Health Coverage Research

Timing and number of interviews– 2003-700 interviews– 2006-700 interviews

Representative of the 12 county area Random digit dialing Decision maker with one or more children who

are less than 19 years of age

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88.3

64.6

19.7

8.7 7.0

89.1

67.6

18.4

7.1 6.9

0

10

20

30

40

50

60

70

80

90

100

%

Work Medicaid CHIP Private PurchaseHouseholds

with Children Covered If Covered, Source of Coverage

2003 2006

Rate of Insured Children

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Comparison to CDC - % Uninsured

Year of Study

CDC US

Houston Area

CDC Texas

2003 10.1% 11.7%

2005 8.9% 17.6%

2006 10.9%

Improving in the Houston area and the US Our belief is the Houston area results are better than Texas as a whole But, almost 170,000 children are uninsured (could fill 3 Astrodomes)

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0

3

6

9

12

15

18

21

24

%

2003 (P=.002)

2006 (P=.004)

White Hispanic / Latino Black / African American

Other

18.0%

16.2%

9.0% 9.0%

11.4%

8.2% 7.7% 6.7%

Uninsured Children by Race

As confirmed by other studies, the Hispanic/Latino population has the highest uninsured children rates

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Why are Children Uninsured?

Of those parents who work:– 29% do not have the option to purchase coverage at work

Looking specifically at the uninsured:– 64.5% do not have the option to purchase coverage at work– 31.6% do not qualify for CHIP or Medicaid

Regardless, it is a money issue:– $70/month: What they say they can afford– $291/month: Average estimate of premium for those who are

insured

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Unfortunate consequences of being uninsured

Do you take your children to a family doctor or pediatrician on a regular basis?

2003: Overall, 82.0% said Yes (86.2% with insurance, 50.0% with no insurance, P=.000) 2006: Overall, 83.1% said Yes (87.2% with insurance, 50.0% with no insurance, P=.000)

Have you taken any of your children to a specialist during the last 12 months?

2003: Overall, 42.3% said Yes (44.7% with insurance, 24.4% with no insurance, P=.000) 2006: Overall, 43.0% said Yes (46.0% with insurance, 18.4% with no insurance, P=.000)

When your (uninsured) child gets sick and needs medical attention, where do you take them?

2003: Overall, 32.9% said to an ER/hospital 2006: Overall, 27.6% said to an ER/hospital

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Other Salient Points

Parents know about CHIP and Medicaid coverage2003 2006

Chip: 61.0% 71.1%

Medicaid: 67.1% 77.6%

Costs are increasing– Premiums, co-pays, and deductibles

Employee policy churn– Almost 40% of households state their children have been

under 3 or more policies since birth

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Agenda

Research on children’s health coverage Research on effects of continuous eligibility

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CHIP Eligibility and Cost Study

Timeframe – June 2000 through June 2004 Average member cost per member per month

– Consumption of health care in month one through month 24

Aggregated costs of all members by month of eligibility

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Total Claims Dollars Per Member Per Month

Total Claims Dollars Per Member Per Month (Illustration 1)

$0.00

$6.00

$12.00

$18.00

$24.00

$30.00

$36.00

$42.00

$48.00

$54.00

$60.00

$66.00

$72.00

$78.00

$84.00

Month1

Month3

Month5

Month7

Month9

Month11

Month13

Month15

Month17

Month19

Month21

Month23

by month of enrollment

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Primary Care Physician Costs

$0.00

$4.00

$8.00

$12.00

$16.00

$20.00

$24.00

$28.00

$32.00

Month1

Month3

Month5

Month7

Month9

Month11

Month13

Month15

Month17

Month19

Month21

Month23

by month of enrollment

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Emergency Room Costs

$0.00

$2.00

$4.00

$6.00

$8.00

$10.00

$12.00

Month1

Month3

Month5

Month7

Month9

Month11

Month13

Month15

Month17

Month19

Month21

Month23

by month of enrollment

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Inpatient Hospital Care Costs

$0.00

$4.00

$8.00

$12.00

$16.00

$20.00

$24.00

Month1

Month3

Month5

Month7

Month9

Month11

Month13

Month15

Month17

Month19

Month21

Month23

by month of enrollment

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Correlation of Enrollment Duration and Length of Eligibility

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Month 1 Month 7 Month 13 Month 19 Month 25 Month 31 Month 37 Month 43 Month 49

Members enrolled between June 2000 and May 2001

Members enrolled between June 2001 and September 2003

Members enrolled after September 2003

Impact of reducing eligibility from 12 months to 6 months

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Results

“The decline in costs suggests that sustained enrollment and continuous access to health care providers results in a reduction in average cost over time”

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Thank you