Photo: Michael R. Cousineau, Dr.PH (by Don Milici)
Nearly 4,500 low-income immigrant children, or 20 percent of
overall membership, dropped out of a public health insurance program in
Los Angeles County due to a premium increase, according to a 30-month
analysis led by University of Southern California (USC) researchers.
The research shows that while most families paid a higher premium to
keep their children insured, other families were unable to do so. The
study was released yesterday in the February issue of Health Affairs, a peer-reviewed
health policy journal.
“It isn’t surprising that a substantial portion of participants
dis-enrolled, but rather that a large percentage found a way to stay
with the program,” said the study’s principal author, Michael R.
Cousineau, Dr.PH, associate professor of family medicine and
preventive medicine at the Keck School
of Medicine of USC. “These results speak to the strong importance
these parents place on retaining coverage.”
Cousineau, who holds a joint appointment at the USC Price School of Public
Policy, and his team examined the county’s Healthy
Kids
program, a comprehensive, full-risk plan established in 2003 that, at
its peak, served more than 45,000 children ages 0 to 18. Administered
by L.A. Care Health Plan, the
program has shrunk due to state budget cuts, closing enrollment to new
applicants ages 6 to 18 in 2008 and increasing monthly premiums to $15
per child ($45 maximum per family) for the same age group in 2010.
Members of the plan had been paying $0 to $6 in premiums per child,
depending on income.
The researchers compared two groups of children, those ages 6 to 18
(subject to a premium increase) and those ages 0 to 5 (who were not
subject to an increase). The researchers compared average monthly
enrollment and retention rates from January 2009 to June 2011. Premiums
increased on July 1, 2010.
Membership declined for both age groups over the course of the study,
but more drastically in the older group subject to premium increases.
Retention in the younger group stayed steady at 95 percent before and
after the increase, while that in the older group dropped nearly 5
percentage points to 93.8 percent after the premium change.
At the end of the study, 59 percent of the older group’s July 2010
monthly enrollment was still in the program. The researchers expected
that 80 percent of the children in the older group would still be
enrolled after the increase, taking into consideration factors other
than a premium increase. The difference between the observed and
expected values is considered the effect of the premium increase.
The researchers did not ask parents why they dis-enrolled their
children, nor did they have access to demographic factors such as
income, race or health status to help identify who was likely to retain
coverage and who was not when faced with increased premiums. Cousineau
said that future research should analyze these and other factors to
tailor specific interventions to children most likely to drop out.
“Health reform provides new opportunities for expanding children’s
access to health care,” Cousineau said. “However, changes in federal,
state and local government policies may force health plans to consider
increasing premiums. More research is necessary to determine the
optimal level for premiums and to project what low-income families
might do if they lose coverage.”
Co-authors include Howard Kahn,
CEO of L.A. Care Health Plan, and Kai-Ya Tsai,
MSPH, a statistician at the Keck School. The study was supported by
funds from L.A. Care Health Plan.