From the U.S. Government Accountability Office, www.gao.gov

Transcript for: Children's Health Insurance Coverage and Costs

Description: Audio interview by GAO staff with Katherine Iritani,
Director, Health Care

Related GAO Work: GAO-14-40: Children's Health Insurance: Information on
Coverage of Services, Costs to Consumers, and Access to Care in CHIP and
Other Sources of Insurance

Released: December 2013

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[ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and
information from the U.S. Government Accountability Office. It's
December 2013. In 2012, more than 8 million children were enrolled in
the Children's Health Insurance Program, a federal and state program
that finances health care for certain low-income children. A team led by
Katherine Iritani, a director in GAO's Health Care team, recently
reviewed children's health insurance coverage and costs. GAO's Sarah
Kaczmarek sat down with Katherine to talk about what they found.

>> Sarah Kaczmarek: For kids enrolled in the Children's Health Insurance
Program, what sorts of services are covered?

[ Katherine Iritani: ] The Children's Health Insurance Program—otherwise
known as CHIP—provides comprehensive health coverage for kids. We looked
at five states' CHIP plans and found that most of them covered a pretty
long list of services. These included physician and hospital services;
emergency care; mental health and substance abuse services; prescription
drugs; lab services; well child and preventative care; pediatric dental,
vision, and hearing services; and outpatient therapies and labs, among
others. There were a small number of services—eye glasses, hearing aids,
and certain therapy services—that were not covered by all of the CHIP
plans we looked at. There were also different types of limits imposed on
some of the services that varied among plans. But otherwise all of the
services we examined were covered by CHIP. That's pretty comprehensive.

[ Sarah Kaczmarek: ] Well, then how much do people pay for these
services?

[ Katherine Iritani: ] Amounts that consumers pay for services, such as
premiums, copayments, coinsurance, and deductibles vary among states and
plans, so consumers' costs will depend on the plan they're enrolled in
and other factors, such as family income, size, and services they use.
Consumers' costs were almost always less than the CHIP plans compared to
the other commonly purchased health plans in the states we reviewed. For
example, an office visit to a specialist in Colorado would cost a CHIP
enrollee around 2 dollars to 10 dollars per visit, depending on their
income, compared to 50 dollars per visit for the benchmark plan that we
looked at in that state. For children covered by CHIP, the federal law
establishes a maximum amount for premiums and cost-sharing, which are
relatively low. For example, premiums and cost-sharing for health
services cannot exceed five percent of a family's total income in the
CHIP program.

[ Sarah Kaczmarek: ] Now, what impact would the Patient Protection and
Affordable Care Act have on this program?

[ Katherine Iritani: ] That's a good question. The Act appropriated
federal funding for CHIP through 2015. But Congress will need to act in
the future to extend funding beyond that time. At some point, if states
can't pay to cover all CHIP-eligible children, they'll be required to
enroll eligible children in comparable qualified health plans on the
exchanges. The exchanges, by the way, are the marketplaces for
healthcare coverage that have gotten lots of attention lately. For those
that are purchasing coverage on exchanges, particularly low-income
families, there are a number of cost-related protections. For example,
cost-sharing may be limited to certain thresholds, and individuals and
families may be eligible for tax credits to offset costs of coverage.

[ Sarah Kaczmarek: ] Well, then do kids in this program have the same
access to care compared with other kids, say, nationwide?

[ Katherine Iritani: ] Most indicators suggest they do. When asked about
access to care in national surveys, about nine in every ten parents or
guardians of children in CHIP reported having a usual source of care,
ease in getting an appointment when needed, and getting care as soon as
it was needed. Their responses were generally comparable to those with
private insurance or Medicaid, but better than those without insurance.
The area of greatest dissatisfaction appeared to be related to seeing
specialists, which about one in five respondents suggested wasn't always
easy for them.

[ Sarah Kaczmarek: ] Finally, for consumers concerned with kids' health
insurance, what's the bottom line here?

[ Katherine Iritani: ] There are a lot of moving parts in the Affordable
Care Act. So it's going to be some time before the effects of the Act on
cost coverage and access will be understood. What is clear is that
Congress cares about ensuring that children have access to affordable
health care. There are tens of millions of children and families that
are benefiting from the federal and state Medicaid and CHIP programs and
having affordable health coverage. And in coming years, we expect the
number of insured children to go up as currently uninsured children gain
access to health coverage.

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