QuickTake: Health Care Access and Affordability for Children and Parents: Changes between 2013 and 2017

 

Michael Karpman and Genevieve M. Kenney

September 7, 2017

 

The expansion of health insurance coverage under the Affordable Care Act (ACA) increased health care access, use, and affordability for nonelderly adults (Glied, Ma, and Borja 2017; McMorrow et al. 2017; Sommers, Blendon, and Orav 2016; Wherry and Miller 2017). Additional coverage gains for children, combined with spillover effects from parents’ stronger connections to the health care system, were expected to improve children’s access to care as well (Davidoff et al. 2003; DeVoe et al. 2011; Howell and Kenney 2012; Gifford, Weech-Maldonado, and Farley Short 2005; Guendelman and Pearl 2004). However, recent efforts to repeal the ACA would have reversed recent coverage gains (CBO 2017a, 2017b), making health care less affordable for many families with children. Although attempts to repeal the ACA have not yet succeeded, some policymakers continue to pursue repeal, and families’ access to coverage and care will also depend on key upcoming decisions related to CHIP funding reauthorization and the federal budget.

 

In this QuickTake, we use data from the Health Reform Monitoring Survey (HRMS) to assess trends in health care access and affordability for children ages 17 and younger and parents ages 18 to 64 living with dependent children since the period just before implementation of the ACA’s major coverage provisions in 2014. We provide updated estimates of changes in access and affordability through March 2017.

 

The Urban Institute has used the HRMS, including questions from the HRMS child supplement (HRMS-Kids), to examine trends in health care access and affordability since 2013. A previous analysis found that between June/September 2013 and March 2016, more parents and children received routine checkups, fewer parents had problems paying family medical bills or had unmet need for health care because of costs, and more parents felt confident that their children could get health care if needed (Karpman et al. 2016). The data and methods used in this analysis are described in the earlier brief, though estimates from that brief are not directly comparable to those from this analysis because of changes in survey weighting procedures.1

 

We find that the share of parents with a usual source of care increased 3.7 percentage points and the share of children with a usual source of care increased 2.3 percentage points between June/September 2013 and March 2017 (figure 1). The shares of parents and children who had a routine checkup in the past year also increased 3.8 percentage points and 4.7 percentage points respectively. We did not find statistically significant changes in difficulty finding a doctor for either group. The share of parents and children with a usual source of care and the share of children who received a routine checkup was higher in March 2017 than in March 2016 (data not shown), even though rates of coverage did not change during this period (Karpman and Kenney 2017); this may indicate a lag between obtaining coverage and becoming more connected to the health care system.

 

 

Families with children also experienced improvements in health care affordability between June/September 2013 and March 2017. The share of parents with an unmet need for care because of costs fell 4.6 percentage points, and the share of parents reporting problems paying family medical bills fell 4.9 percentage points (figure 2). Reported problems paying children’s medical bills declined 3.3 percentage points, and the share of respondents who were very or somewhat confident that their child could get health care if he or she needed it increased 2.9 percentage points. We also found a 2.3 percentage point increase in reported unmet need for care because of costs among children, though this result is not consistent with recent data from the National Health Interview Survey.

 

 

Despite gains in some measures of access and affordability, many parents and children still face barriers to getting the health care they need. In March 2017, one in ten children and nearly one in five parents had trouble finding a doctor in the 12 months before the survey (table 1). In addition, 26.0 percent of parents and 16.8 percent of children had an unmet need for care because of costs,2 and over one in five parents (21.6 percent) had problems paying family medical bills.

 

Whether recent improvements in health care access and affordability for parents and children are sustained and expanded upon will depend on efforts to protect the coverage gains achieved under the ACA. Families with children have much at stake as policymakers consider the fate of major federal health care programs this fall.

 

Table 1. Health Care Access and Affordability for Parents Ages 18 to 64 and Children Ages 17 and Younger, June/September 2013 through March 2017

 

June/September 2013

March 2017

Parents

     

Access

     

Has one or more usual sources of care

71.9%

75.6%

***

Had a routine checkup in past 12 months

59.9%

63.7%

**

Had trouble finding a doctor in past 12 months

20.9%

19.3%

 

Affordability

     

Any unmet need for care because of costs in past 12 months

30.6%

26.0%

***

Problems paying family medical bills in past 12 months

26.5%

21.6%

***

Children

     

Access

     

Has one or more usual sources of care

92.2%

94.4%

***

Had a routine checkup in past 12 months

82.3%

87.0%

***

Had trouble finding a doctor in past 12 months

10.2%

10.4%

 

Affordability

     

Any unmet need for care because of costs in past 12 months

14.6%

16.8%

*

Problems paying child’s medical bills in past 12 months

13.3%

10.0%

***

Very or somewhat confident child could get health care if he or she needed it

93.2%

96.2%

***

       
Sample size for parents

4,810

2,977

 
Sample size for children

5,121

3,153

 
Source: Health Reform Monitoring Survey, quarters 2–3 2013 through quarter 1 2017.
Notes: Estimates are regression-adjusted. “Trouble finding a doctor” for children includes difficulty finding a general doctor, specialist, or dentist. “Unmet needs for care” for parents include prescription drugs; medical care; general doctor care; specialist care; tests, treatment, or follow-up care; and mental health care or counseling. “Unmet needs for care” for children include prescription drugs; medical care; general doctor care; specialist care; tests, treatment, or follow-up care; mental health care or counseling; and eyeglasses or vision care.
*/**/*** Estimate differs significantly from estimate for June/September 2013 at the 0.10/0.05/0.01 level, using two-tailed tests.

References

 

CBO (Congressional Budget Office). 2017a. Cost Estimate: H.R. 1628, American Health Care Act of 2017. Washington, DC: CBO.

 

———. 2017b. Cost Estimate: H.R. 1628, Better Care Reconciliation Act of 2017. Washington, DC: CBO.

 

Davidoff, Amy, Lisa Dubay, Genevieve M. Kenney, and Alshadye Yemane. 2003. “The Effect of Parents’ Insurance Coverage on Access to Care for Low-Income Children.” Inquiry 40: 254–68.

 

DeVoe, Jennifer E., Carrie J. Tillotson, Lorraine S. Wallace, Heather Angier, Matthew J. Carlson, and Rachel Gold. 2011. “Parent and Child Usual Source of Care and Children’s Receipt of Health Care Services.” Annals of Family Medicine 9 (6): 504–13.

 

Gifford, Elizabeth J., Robert Weech-Maldonado, and Pamela Farley Short. 2005. “Low-Income Children’s Preventive Services Use: Implications of Parents’ Medicaid Status.” Health Care Financing Review 26 (4): 81–94.

 

Glied, Sherry, Stephanie Ma, and Anaïs A. Borja. 2017. “Effect of the Affordable Care Act on Health Care Access.” New York: Commonwealth Fund.

 

Guendelman, Sylvia, and Michelle Pearl. 2004. “Children’s Ability to Access and Use Health Care.” Health Affairs 23 (2): 235–44.

 

Howell, Embry M., and Genevieve M. Kenney. 2012. “The Impact of the Medicaid/CHIP Expansions on Children: A Synthesis of the Evidence.” Medical Care Research and Review 69 (4): 372–96.

 

Karpman, Michael, and Genevieve M. Kenney. 2017. “QuickTake: Health Insurance Coverage for Children and Parents: Changes between 2013 and 2017.” Washington, DC: Urban Institute.

 

Karpman, Michael, Genevieve M. Kenney, Stacey McMorrow, and Jason A. Gates. 2016. “Health Care Coverage, Access, and Affordability for Children and Parents: New Estimates from March 2016.” Washington, DC: Urban Institute.

 

McMorrow, Stacey, Jason A. Gates, Sharon K. Long, and Genevieve M. Kenney. 2017. “Medicaid Expansion Increased Coverage, Improved Affordability, and Reduced Psychological Distress for Low-Income Parents.” Health Affairs 36 (5): 808–18.

 

Sommers, Benjamin D., Robert J. Blendon, and E. John Orav. 2016. “Changes in Utilization and Health among Low-Income Adults after Medicaid Expansion or Expanded Private Insurance.” JAMA Internal Medicine 176 (10): 1501–09.

 

Wherry, Laura R., and Sarah Miller. 2017. “Early Coverage, Access, Utilization, and Health Effects Associated with the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study.” Annals of Internal Medicine 164 (12): 795–803.

 

Notes


1 In January 2017, we reweighted all rounds of the HRMS from the first quarter of 2013 through the third quarter of 2016 because of a change to the Current Population Survey question on household Internet access that was used to create benchmarks for the original poststratification weights. Under the new procedure, the data are weighted to represent the nonelderly population’s lack of Internet access by age group (18 to 34, 35 to 44, 45 to 54, and 55 to 64 for adult weights; birth to 6, 7 to 12, and 13 to 17 for child weights), based on benchmarks derived from a more stable set of questions on household Internet access from the American Community Survey. Other Current Population Survey and Pew Hispanic Survey questions used in the weighting process are unchanged. The transition to the updated weights has a small effect on national estimates. For instance, in the quarter 1 2016 round of the survey, the unadjusted estimated uninsurance rate is 0.22 percentage points lower for children and 0.03 percentage points lower for parents under the new weights. The effect of reweighting on estimated changes in key outcomes over time is small because the new weighting procedure was applied to all previous rounds of the data. However, because of this change, estimates in this brief are not comparable to estimates in previous HRMS publications. In addition, the HRMS sample size was expanded to approximately 9,500 adults ages 18 to 64 in March 2017, producing a sample size of over 3,000 children in the HRMS-Kids. In previous rounds, the HRMS sample size was about 7,500 adults, with approximately 2,400 children in the HRMS-Kids. ^

 

2 For parents, “unmet needs for care” include prescription drugs; medical care; general doctor care; specialist care; tests, treatment, or follow-up care; and mental health care or counseling. For children, “unmet needs for care” include prescription drugs; medical care; general doctor care; specialist care; tests, treatment, or follow-up care; mental health care or counseling; and eyeglasses or vision care. ^

 

About the Series

 

This QuickTake is part of a series drawing on the HRMS, a survey of the nonelderly population that explores the value of cutting-edge Internet-based survey methods to monitor the ACA before data from federal government surveys are available. Funding for the core HRMS is provided by the Robert Wood Johnson Foundation and the Urban Institute. This QuickTake was funded by the David and Lucile Packard Foundation and funding from an anonymous donor. It draws on the HRMS-Kids, which was conducted in partnership with the Center for Children and Families at Georgetown University and is currently funded by the David and Lucile Packard Foundation. The authors are grateful to Stephen Zuckerman for helpful comments on this QuickTake.

 

For more information on the HRMS and for other QuickTakes in this series, visit www.urban.org/hrms.

 

About the Authors

 

Michael Karpman is a research associate and Genevieve M. Kenney is a senior fellow and codirector with the Urban Institute’s Health Policy Center.

 

Urban Institute Robert Wood Johnson Foundation