Health Coverage for Children: Where do we stand? Joan Alker/Sabrina Corlette Georgetown Health Policy Institute February 4, 2014

Source: Georgetown University Center for Children and Families analysis of estimates from the US Census Bureau’s 2011 American Community Survey. Source: Georgetown University Center for Children and Families analysis of estimates from the US Census Bureau’s 2011 American Community Survey. Note: Coverage sources are not mutually exclusive. Children may have more than one source of coverage. 2 Children = 72.8 million How Children Are Covered, % of Low- income children are on Medicaid/CHIP

Children’s Coverage Under the ACA Source: Urban Institute’s Health Insurance Policy Simulation Model, “Improving Coverage for Children Under Health Reform Will Require Maintaining Current Eligibility Standards for Medicaid and CHIP”, Health Affairs, 30, no. 12 (2011) 3 An estimated two million children will have individual market exchange coverage

SOURCES: State decisions on the Medicaid expansion as of October 21, Based on data from the Centers for Medicare and Medicaid, Kaiser Family Foundation and state legislative scan by Georgetown CCF. Status of Medicaid Expansions (1/1/31) Moving Forward at this Time (26 States including DC) Not Moving Forward at this Time (20 States) Ongoing Discussion (5 States) 4 States with Extended Waivers (2 States)

5 Open Enrollment: Mid-Way Point Rates lower than projected vs. “rate shock” Early renewals and policy cancellations Rocky websites Back end glitches SBMs outperforming FFMs Coverage gaps Provider network issues

Open Enrollment: Mid Way Point Continued lack of awareness Where are the Uninsured? 7 in 10 uninsured adults have not yet been to marketplace 69% do not know financial help is available Main reason uninsured? “I can’t afford it.” 69% 81% do NOT know about March deadline Uninsured adults in 30s less likely to know about options than other age cohorts Source: Enroll America, Results from a National Survey of Uninsured Adults 18 to 64 Conducted Dec , 2013; KFF January 2014 tracking poll 47% have unfavorable view 24% have favorable view

7 Open Enrollment: Mid-Way Point Enrollment Status o Web Site and Call Center Activity o 53.2M visits to websites o 11.3M calls to call centers o Eligibility Determinations and Plan Selection o 3 M have selected plan o Public program data is not yet very useful Source: Assistant Secretary for Planning & Evaluation, HHS Monthly status report October 1-Dec. 28, 2013 and Centers for Medicare and Medicaid Services

8 Open Enrollment: Mid-Way Point Enrollment Status Breakdown: Gender – 46% Male – 54% Female Breakdown: Age – 6% < 18 – 24% between – 55% between o Breakdown: Popular Plans o 20% Bronze o 60% Silver o 13% Gold o 7% Platinum o 1% Catastrophic o Breakdown: Subsidies o 79% receiving subsidies Source: Assistant Secretary for Planning & Evaluation, HHS Monthly status report October 1-Dec. 28, 2013

9 ACA Marketplaces: Policy Issues to Watch Cost-sharing Benefits Employer-based coverage Enrollment Premiums Narrow networks Provider capacity

10 ACA Marketplaces: Issues for Families Coverage problems Use of services Churn Reconciliation E&E Assistance Health insurance literacy Appeals

Children’s Coverage in the United States, % of separate CHIP kids moving to Medicaid

National Eligibility Levels, Potential Coverage Gap

Premium cost for: Income of: Self-only Household > 9.5% Subsidies for an employee with an ESI coverage offer Are available only if: 13 Affordability Test - Individual

Premium cost for: Income of: Self-only Household > 9.5% Subsidies for a family with an ESI coverage offer Are available only if: 14 Affordability Test – Family Glitch

Premium cost for: Income of: Household > 9.5% Subsidies for a family with an ESI coverage offer Are available only if: 15 Affordability Test – Preferred Outcome

FUTURE OF CHIP? 16

CHIP Funded through 2015 o Maintenance of Effort through 2019 o Family glitch and other glitches underscore the need for CHIP to continue o Future Key question – How will marketplace coverage work for kids? o Recent GAO study was limited in scope – found benefits similar but not cost-sharing o CMS comparability study later this year? o CCF/NASHP benefits study coming soon but much more work is needed 17

Future of CHIP: State Directions? 18

Future of CHIP o Arkansas approach – using Medicaid/CHIP to buy marketplace coverage o Cost effective?? o Will kids get the same benefits? o Family together? o Access to providers? o Arizona – world with no MOE – kids in exchange o Family glitch, enrollment glitches o Benefits/cost-sharing o California - CHIP is a financing source for Medicaid 19

For More Information o Joan Alker: o o ccf.georgetown.edu ccf.georgetown.edu o o Sabrina Corlette o o chir.georgetown.edu chir.georgetown.edu o