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Health Aff (Millwood). 2017 Apr 1;36(4):616-625. doi: 10.1377/hlthaff.2016.1280.

Low-Income Children With Chronic Conditions Face Increased Costs If Shifted From CHIP To Marketplace Plans.

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Alon Peltz ( is a postdoctoral fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at the Yale School of Medicine, in New Haven, Connecticut.
Amy J. Davidoff is senior research scientist in the Department of Health Policy and Management at the Yale School of Public Health and a member of the Yale Cancer Center and the Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER), Yale School of Medicine.
Cary P. Gross is a professor of medicine in the Department of Internal Medicine; a founding director of COPPER; and codirector of the Robert Wood Johnson Foundation Clinical Scholars Program and the National Clinician Scholars Program, all at the Yale School of Medicine.
Marjorie S. Rosenthal is an associate professor in the Department of Pediatrics and assistant director of the Robert Wood Johnson Foundation Clinical Scholars Program and the National Clinician Scholars Program, both at the Yale School of Medicine.


More than eight million children risk having their health insurance coverage disrupted if federal funding for the Children's Health Insurance Program (CHIP) is not extended beyond 2017. In this study we explored two current policy alternatives: extending federal funding for CHIP or enrolling children in the existing health insurance Marketplace plans. We simulated annual out-of-pocket expenses using detailed health plan data from CHIP and federally facilitated Marketplace plans for a nationally representative cohort of children with chronic conditions, conducting comparisons at four different percentage categories of the federal poverty level. If CHIP funding is not renewed and children with chronic conditions shift to coverage under Marketplace plans, their families face increased annual out-of-pocket expenses ranging from $233 at the lowest income levels to $2,472 at the highest income level of 251-400 percent of poverty. Families with children who have epilepsy, diabetes, or mood disorders may face the highest costs. Cost sharing for prescription drugs (25 percent) and hospitalizations (23 percent) account for much of the difference. Absent enhancements to Marketplace cost-sharing protections, and given recent efforts to repeal the Affordable Care Act, renewing funding for CHIP will provide the greatest financial protections to families of income-eligible children with chronic conditions.


Children’s Health; Chronic Care; Cost of Health Care; Financing Health Care; Insurance Market < Insurance


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