DPM researchers and colleagues conducted a telephone survey in 2012 with parents of asthmatic children about their experiences during the prior year within an integrated health care delivery system. Respondents included 769 parents of children aged 4 to 11 years with asthma. Of these, 25.9% of children received public subsidies; 21.7% were commercially insured with household incomes at or below 250% of the federal poverty level (FPL), and 18.2% had higher cost-sharing levels for all services (e.g., ≥$75 for emergency department visits). Asthmatic children were classified based on (1) current receipt of a subsidy (ie, Medicaid or Children’s Health Insurance Program) or potential eligibility for the Affordable Care Act low-income cost-sharing or premium subsidies in 2014 and (2) cost-sharing levels for prescription drugs, office visits, and emergency department visits.
The main outcome measures included switching to cheaper asthma drugs, using less medication than prescribed, delaying/avoiding any office or emergency department visits, and financial stress (e.g., cutting back on necessities) because of the costs of asthma care.
Study results demonstrated that commercially-insured families with higher levels of cost-sharing and with incomes at or below 250% of the FPL, were significantly more likely to delay or avoid office or emergency room visits for their child’s asthma or to borrow money to pay for their child’s care. Higher-income families and low-income families with lower levels of cost-sharing through existing subsidies (Medicaid and Children’s Health Insurance Program) were less likely to report these behaviors.
DPM study authors Alison Galbraith, MD, MPH and Ann Wu, MD, MPH, and their colleagues note that expanded insurance subsidies starting in 2014 could offer some protection from cost barriers and financial stress but, due to a family glitch, these subsidies are unavailable to millions of dependents for whom employer-sponsored family coverage might be unaffordable. Clearly, to inform policy refinements, work is needed to assess the effects of the Affordable Care Act and possible gaps in subsidy access.
To read the study abstract in JAMA Pediatrics, click here.