Interim Evaluation Report: Congressionally Mandated Evaluation of the State Children’s Health Insurance Program. A. perceptions of the value of ScHIP and Medicaid


Low-income parents participating in focus groups across the country have wide-ranging concerns about their children's education, safety, and health, including health insurance coverage. All these concerns, they say, contribute to their placing a high value on health insurance. Families who participated in focus groups were those interested enough in insurance to attend a focus group, and thus may not represent all low-income families. However, their response was powerful and was consistent across families with different types of insurance coverage (that is, private insurance, Medicaid, SCHIP, and uninsured), different racial and ethnic groups, geographic locations, and primary language (Spanish, English, and other languages).

Focus group participants cited several advantages of having health insurance for their children. In particular, they mentioned freedom from worry about the high cost of a major injury or illness, the ability to take their children for preventive care and to treat acute conditions early, and access to private-sector health care providers and a wide range of benefits. The value families placed on health insurance stemmed from concerns about their children's health and their ability to pay for medical care. Although they used different languages and different words to describe it, the "peace of mind" that comes with health insurance coverage was an important benefit and source of comfort to many parents. For example:

"If you have insurance you don't have to worry about where you are going to get the money to take your child to the doctor or to the emergency room. You just make the appointment and you know you can pay the co-payment. You don't have to worry about it. You don't have to just give them Tylenol and hope it doesn't get any worse. It's just easier money-wise when you have insurance." (San Antonio, Texas)

Many parents in focus groups also believed that having health insurance improved their children's access to care; that is, they reported that their children receive services they otherwise would not, or that they receive better or more timely care, when they are insured. For example:

". . . I believe one of my major benefits for my son will be that he can have one doctor. When you go to health clinics or go to Highland or Acute Care or whatever you see a different doctor each time and no one really knows your case." (Oakland, California)

In addition to their appreciation of the value of health insurance, parents of children enrolled in Medicaid and SCHIP appreciated the coverage and services they received specifically through these programs. In general, families expressed high levels of satisfaction with the benefits, providers, and services available to them under both Medicaid and SCHIP. In many cases, families reported that the range of benefits covered by these programs exceeded their expectations; services that parents were particularly grateful to have covered included prescription drugs, dental care, and vision care. In addition, focus group participants frequently cited the quality of their children's physicians as a source of satisfaction. Finally, a major attraction of Medicaid was that it is free for children; many parents likewise cited the low cost of SCHIP coverage as a significant advantage:

"Like my 20 month old. They go to the doctor every time you turn around. And a lot of it is just well visits and...immunizations, but...if you actually go and try to pay for something like that it's like $100-$150 just for one visit...that's a lot of money. And insurance, whether you're paying for it yourself, the full premium or whatever, it pays for itself just that first two years." (Tampa, Florida)

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