By Katie Kerwin McCrimmon
Gov. John Hickenlooper vetoed Senate Bill 11-213 on Tuesday, saying that the bill, which would require families to share the cost of their children’s health care under the Child Health Plan Plus program, would negatively affect access to health insurance for a vulnerable population.
“Expecting low-income families in Colorado to contribute when it comes to providing for, and placing a priority upon, their health care, makes sense,” Hickenlooper said in a letter to the General Assembly. “What is troubling about this legislation, however, is not the policy intent, but the practical, and negative impact, it will have on children in low-income families.
His veto came on heels of release of a study that found that parents at all income levels are deliberately going without or delaying medical care for their children as health costs rise.
“Families aren’t choosing to spend their money on going to the doctor when someone is sick because of how much it cost them to see the doctor last time,” said lead researcher, Lauren E. Wisk, a doctoral student and graduate research assistant in the School of Medicine and Public Health at University of Wisconsin, Madison. “They’re sacrificing their health because it costs too much to be healthy.”Once medical costs exceed 10 percent of family income — regardless of how high that income is — the analysis shows that people across the U.S. are either forgoing or postponing medical care.
Even families with health insurance are skipping care.
Wisk unveiled the study results during the annual meeting of the national Pediatric Academic Societies in Denver this month.
The concept of rationing health care has become a hot topic as Republicans and Democrats spar over how to rein in health costs as they debate U.S. Rep. Paul Ryan’s controversial proposal to change financing for Medicare. While policymakers argue over rationing, it’s clear that families poring over bills at kitchen tables are already rationing care for themselves.
“Whether or not we think we’re doing this on a policy level, people are doing this on a family level,” Wisk said. “Some people are making hard choices. We’re seeing health care rationing because costs are high and people’s incomes are not rising as fast.”
Under SB 11-213, families of four earning about $46,000 to $56,000 per year would have had to pay new monthly insurance premiums of $20 for their first child, $10 each for additional children and a maximum of $50 per month.
Hickenlooper said he would work with the legislature to develop a better cost-sharing plan and present it to the Joint Budget Committee by Nov. 1, 2011.
“The focus will be to implement a change that is minimally disruptive, administratively efficient, effective and elegant, and supports the goal of ensuring that kids have access to coverage,” he said in the letter.
Opponents of the measure argued that the bill wouldn’t save the state significant money and would cause about 1,500 families to drop CHP+ for their children. People who are uninsured often seek care in emergency rooms where health costs are highest. Proponents of the measure say that families should care enough about their children’s health to share in the cost of public insurance programs. Some proponents say families who earn $50,000 per year are spending some money on luxuries like movies, flat screen televisions and alcohol, and should be required to contribute to rising health expenses.
For her study, Wisk and fellow researchers used data from 6,273 families across the country with at least one child. The data are weighted, meaning that each family statistically represents others, so the results equate to a survey of nearly 12 million families in every geographical region of the country. The Medical Expenditure Panel Survey includes data from 2001 to 2006 prior to the Great Recession. Since then, health costs have climbed while many families have suffered lost jobs or declining wages.
Wisk is planning to continue the study with newer data as it becomes available, and she expects to find even more pronounced results.
“I imagine that we’re going to see more families have delayed or forgone care,” she said.
Among the key findings:
- At all income levels, once health costs rise above 10 percent of income, families are 40 percent more likely to delay or skip seeking health care.
- When a parent’s health insurance is intermittent, family members are more likely to delay or do without medical care.
- Families do better at obtaining health care when all family members share the same health insurance plan. (Programs like CHP+ in Colorado serve as safety nets for children and insure them separately from their parents. Wisconsin has a model called BadgerCare+ that enrolls parents and caregivers in the same insurance program.)
- Having a child with ongoing “activity limitations,” which can range from obesity to asthma, diabetes or autism, increased the likelihood that families skipped or delayed care.
- Rationing strikes people at all income levels. But, the poorest families were more likely to delay or go without care than families at or above 400 percent of poverty levels. (A family of four with an income of about $88,000 per year would be at the poverty level.)
Wisk has been particularly interested in “spillover effects.” If a family is dealing with a child who has a severe illness, caring for that child can lead other family members to delay or skip care.
“The well-being of one family member can affect the health and well-being of the whole family,” she said. “It’s unfortunate. People have to pay a lot of these costs. Especially when you have catastrophic events, people have to make choices. They have a certain amounts for housing, food and utilities. There’s not a whole lot (of income) that is flexible. Sometimes people are making sacrifices in terms of actually going to the doctor.”
Wisk said that policymakers across the country are considering cost-sharing measures like the Colorado measure. She plans to follow up by looking at exactly what happens when people delay or skip care. Does their health suffer?
“It’s tricky,” Wisk said. “Cost-sharing seems like a good way to finance these programs. But increasing the costs even a small amount could be a significant burden to families.”