New research suggests that parents in low-income families were less likely to delay asthma care for their children if they had lower levels of health insurance cost-sharing.
The Patient Protection and Affordable Care Act (ACA) includes subsidies to reduce cost-sharing for low-income families. Limited information about the effects of cost-sharing on care for children is available to guide such efforts.
A 2012 telephone survey that included 769 parents of children with asthma (ages 4 to 11 years). The authors examined the frequency of changes in seeking care and financial stress because of costs. Of the children, 25.9 percent were enrolled in Medicaid or the Children's Health Insurance Program; 21.7 percent were commercially insured with household incomes at or below 250 percent of the federal poverty level (FPL); and 18.2 percent had higher cost-sharing levels for all services (e.g. $75 or more for an emergency department visit).
"The ACA's low-income subsidies could reduce these barriers for many families, but millions of dependents for whom employer-sponsored family coverage is unaffordable could remain at risk for cost-related problems because of ACA subsidy eligibility rules."
Author: Vicki Fung, Ph.D., of Massachusetts General Hospital, Boston, and colleagues.
(JAMA Pediatr. Published online May 19, 2014. doi:10.1001/jamapediatrics.2014.79. .)
Editor's Note: Dr. Fung has a financial interest in Merck. The study was funded by a grant from the Agency for Healthcare Research and Quality. Please see article for additional information, including other authors, author contributions and affiliations, etc.
Editorial: Downside of Increased Cost Sharing
In a related editorial, Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, writes: "Their findings are not surprising, given our prior knowledge about cost sharing."
"The Affordable Care Act will do a great deal to reduce the numbers of the uninsured in the United States. However, having insurance is just the first step toward improved access. Health care is still expensive, and obtaining it is still difficult for many in the United States. As Fung and colleagues have shown us, we cannot ignore cost sharing, especially with respect to lower-income individuals obtaining commercial insurance through the exchanges," Carroll concludes.
(JAMA Pediatr. Published online May 19, 2014. doi:10.1001/jamapediatrics.2014.449. .)