The future of the Children’s Health Insurance Program

by Steffani Bailey

The future of the Children’s Health Insurance Program (CHIP) in the United States is uncertain after 2017. If not reauthorized or similar funding is not available after that date, getting health insurance coverage for some children could be difficult, which in turn, could impact their access to healthcare. This study examined patterns of healthcare utilization among children after Oregon’s 2009-2010 Children’s Health Insurance Program expansion. Using electronic health record data from 154 Oregon community health centers and Medicaid/CHIP data from the state of Oregon, we conducted a study of pediatric patients who gained public insurance coverage during the Oregon expansion (n=3054), compared to those that were continuously publicly insured (n=10,946) or continuously uninsured (n=10,307) during the 2-year study period. We compared pre-post rates of primary care visits, well-child visits, and dental visits within- and between-groups. We also examined monthly visit rates over time, comparing the three insurance groups. We found that newly insured patients’ utilization rates were more than double their pre-expansion rates [adjusted rate ratios (95 % confidence intervals); increases ranged from 2.10 (1.94–2.26) for primary care visits to 2.77 (2.56–2.99) for dental visits]. Utilization among the newly insured spiked shortly after coverage began, then leveled off, but remained higher than the uninsured group. This study used electronic health record data to confirm that CHIP expansions are associated with increased utilization of essential pediatric primary and preventive care. These findings are timely to pending policy decisions that could impact children’s access to public health insurance in the United States.

At the time, our team was examining the impact of an Oregon adult Medicaid expansion (Oregon Experiment) on healthcare utilization by Oregon adults, as well as the impact of this Medicaid expansion on the children of adults who had gained Medicaid coverage. Given the uncertainly of CHIP in the near future, we decided to leverage the electronic health record data from the time of the Oregon CHIP expansion (also known as “Healthy Kids”) to more fully understand the association of children’s insurance coverage and receipt of essential primary and preventive care services among some of our most vulnerable pediatric patient populations.  Hopefully, these findings, along with the results of other research in this area, will help inform important policy decisions regarding children’s access to public health insurance.  Our team is continuing to look at the impact of healthcare reform and other health policy changes, such as the Affordable Care Act and the Meaningful Use of Electronic Health Records Incentive program, on primary and preventive care utilization and outcomes among vulnerable and underserved patient populations.