Relative Affordability of Health Insurance Premiums Under CHIP Expansion Programs and the ACA

Published In: Journal of Health Politics, Policy and Law, v. 36, no. 5, Oct. 2011, p. 859-877

Posted on RAND.org on October 01, 2011

by Carole Roan Gresenz, Miriam Laugesen, Ambeshie Yesus, Jose J. Escarce

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Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that the future of CHIP beyond 2015 is likely to have significant implications for health insurance coverage costs incurred by families who currently rely at least in part on CHIP for coverage.

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