Health insurance coverage for the underserved population is of primary concern due to the impact that it can have on health care access and utilization as well as protection against extreme expense. The purpose of this evaluative study is to increase understanding of barriers and facilitators impacting enrollment into and/or renewal of health insurance programs among parents of school aged children. The program being evaluated provides assistance for parents of school aged children to apply for enrollment or reenrollment into a health insurance plan.
Major research questions are: What are barriers to successful application for health insurance? What factors encourage individuals not enrolled to apply for health insurance? What are the barriers to successful application for re-enrollment for health insurance? What are the factors that encourage successful application for re-enrollment for health insurance? What are perceived benefits of health insurance? How will health insurance be used?
Methods:
The Gateway to Care MACRA Connecting Kids to Coverage IV grant project management staff assists parents of school-age children who are potentially eligible for Medicaid and/or Children’s Health Insurance Program (CHIP) to enroll or reenroll in health insurance plans. For this evaluative study, guided focus groups are being conducted for those parents who have been assisted by program staff to enroll or reenroll in insurance programs for which they are eligible. Recruitment of parents to participate in the focus groups is accomplished via English and Spanish language flyers posted at the schools attended by their children. Group participants are both English and Spanish speaking; thus, groups are conducted in either English or Spanish, with parents choosing the group that uses their preferred language. In addition to the English speaking primary investigator, a translator also is present in the Spanish speaking groups. Groups have no more than 10 participants. On the day of the focus group, the study objectives are explained, and consent forms in English or Spanish are reviewed and signed.
The interview guide is designed to address the following areas related to health insurance: nature of decision-making that results in enrollment, including barriers and facilitators; experience of actually enrolling or renewing; role played by those assisting with enrollment process; perceived benefits to having health insurance; and, primary intended use of health insurance.
Results:
This project is ongoing, with the majority of focus groups to be completed during the spring semester of 2018. However, several trends are noted. Application processes are complex and difficult to understand. Parents often perceive condescension by those designated to help with enrollment. Individuals ‘designated’ to answer questions about the application and/or renewal process sometimes are without the resources to respond in a timely manner to questions. When receiving help from more than one person, different answers are often given regarding requirements. Fear is a primary response to not having insurance and/or to being at high risk of losing insurance; fear is related to catastrophic expense and/or to potential lack of access to care. Families with children with disabilities or chronic illnesses report feeling helpless without insurance and greatly relieved when they have insurance. Simplicity of the application process, availability of assistance, and respect are reported to increase the chances that under-served individuals actually obtain health insurance.
Conclusion:
In addition to an effect on mortality, health insurance also affects quality of life by improving health status, reducing financial burden, and decreasing the odds of depression (Woolhandler & Himmelstein, 2017). Preliminary findings from this study are similar to those found in the literature review. Health care disparities of minority patients include reduced access to care, less intervention, and worse health outcomes (IOM, 2002b). Although multiple factors affect health outcomes for minority patients, lack of insurance and disruptions in insurance are major to health care access and utilization of services. Eliminating health disparities, i.e., inequality in accessing and maintaining quality health care, has been established as a goal by the Department of Health and Human Services (USDHHS, 2000), and evidence suggests that insurance coverage is a primary component necessary to meet this goal. Additional focus groups over the next 4 months will increase clarity about the influences on obtaining and maintaining health insurance.