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Often, private coverage is assumed to be better than public coverage. More and more often, that’s just not what families are finding. Those that work, even those earning a decent living, just can’t afford the private care they’re offered. They have to turn to public insurance.

Related HCT episodes:
1. CHiP Premiums and Low Enrollment: https://www.youtube.com/watch?v=5e1Pw0kxJsQ

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A couple year ago, we covered a study that showed that low-income working families who had coverage through their employers were turning to public insurance for their kids. It pointed to a failure of the employer-provided private insurance market as parents, especially low-income parents, needed to shift to Medicaid or CHIP for their children. There's a new study expanding on this, though. Let's discuss it. This is Healthcare Triage News.

[Intro]

To the research!

Health Affairs, Growth Of Public Coverage Among Working Families In The Private Sector.

Researchers from the CHOP Policy lab looked at enrollment in health insurance from 2008 to 2016. They looked only at families who were working full time and earning at least the poverty level.

As expected, those who were low-income (say 100-199% of the federal poverty line) saw the highest use of public insurance, and it jumped fr 53% to 79% in 2016. Even at large firms, plans for kids proved to be too expensive for families. Over the 8 years study period, public coverage for kids of parents employed by large companies went up almost 25%. 

And, the findings weren't just isolated to the poor families. Moderate income families, earning between 200 and 299 percent of the federal poverty line, saw their need for public coverage of their kids go up from 21% in 2008 to 64% in 2016. That's a huge jump of 46% in absolute terms.

But, the surprising take home message here was how much even coverage of big companies was proving inadequate. Of the 8.6 million kids who had public insurance in this study, more than 70% had a parent who worked at a large private company. In fact, kids with parents who worked at large companies were the biggest driver of the shift from private to public insurance. 

The usual party line here is that small businesses don't provide coverage that's affordable, and, therefore, working at a larger company is better. It's thought that large employers are more likely to be able to offer child coverage at reasonable rates. But, that's not the case! Insurance at all types of companies, even that offered by large companies, is increasingly unaffordable for families.

Remember that policies like work requirements are set up to get more people to work so that they not only earn more, but they get private health insurance coverage for their families. The thought here is that the private coverage is better. More and more often that's just not what families are finding. Those that work, even those earning a decent living, just can't afford the private care they're offered; they have to turn to public insurance. Policies are going to have to recognize this fact and grapple with it if access is going to get better in the future.

[Outro]

If you enjoyed this episode, you might enjoy this other episode on CHIP premiums and low enrollment.

We'd especially like to thank our research associate, Joe Sevits, and, of course, our surgeon admiral, Sam. And, just like them, you can support the show at Patreon.com/HealthcareTriage.

You can also buy my book, The Bad Food Bible, out in paperback.