Uninsured Children: Who Are They and Where Do They Live?

1. Uninsured Children: Who Are They and Where Do They Live? Understanding and Using the Chartbook CKF Webinar, October 25, 2010 3:00-4:30 pm URBAN INSTITUTE

2. About the Chartbook • Goal: Describe insurance patterns among children (aged 0-18) at the state and sub-state level • Data Source: The American Community Survey (ACS) • Annual survey by the U.S. Census Bureau, based on the decennial census long form • Sample Size: 700,000+ children on the ACS Public Use File, about 11 times as many as on the CPS • Health Insurance Coverage, for each individual in the household (since 2008) • Our coverage estimates adjust for underreporting of Medicaid and CHIP coverage • Estimates use survey weights and appropriate standard errors

3. Health Insurance Coverage Question, 2008 ACS Is this person CURRENTLY covered by any of the following types of health insurance or health coverage plans? Mark “Yes” or “No” for EACH type of coverage in items a–h. a. Insurance through a current or former employer or union (of this person or another family member) b. Insurance purchased directly from an insurance company (of this person or another family member) c. Medicare, for people age 65 and over, or people with certain disabilities d. Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability e. TRICARE or other military health care f. VA (including those who have ever enrolled for or used VA health care) g. Indian Health Service h. Any other type of health insurance or health coverage plan—Specify

4. U.S. Summary Exhibits and Tables • National maps with uninsured rate for each state (Exhibit 1 & 2) • All children and low-income (<200% FPL) children • Tables describing the insured and uninsured nationally (Table 1 & 2) • Summary charts ranking states/regions on: • Uninsured rates by demographic characteristics (Exhibit 3-12) • Share of insured and uninsured with various demographic characteristics (Exhibit 13-22)

6. Ranking of States’ Uninsured Rates by Specific Characteristic • (Exhibit 3-12) U.S. Average Shown here: Ranking of States by Uninsured Rates among Low-Income (<200% FPL) Children

7. Ranking of States’ Share of Uninsured with Specific Characteristics • (Exhibit 13-22) Shown here: Ranking of States by Share of Uninsured Children who are Low-Income (<200% FPL)

8. State-Specific Summary Exhibits and Tables • Maps with overall uninsured rate by sub-state region, defined as Public Use Microdata Areas, PUMAs (Map 1 – 51) • There are 2,000+ non-overlapping PUMAs across the country, each with a population of at least 100,000 • Tables describing the insured and uninsured in each state • Uninsured rate by demographic characteristic, comparing U.S. average to specific state (Table 1) • Characteristics of children by insurance status (insured, uninsured) and poverty level (All, <200% FPL, <300% FPL) (Table 2)

9. Utah

10. Demographic Variables Considered • Household Characteristics: • English-Speaking in Home (Parents and Adults) • Married Parents • Educational Attainment of Parents • Employment of Parents • HIU Income • Access to Phone • Moved in Last 12 Months • Food Stamp Household • Child Characteristics: • Age • Sex • Ethnicity/Race • Citizenship Status

11. Table 1: Uninsured rate… • By Demographic Variables: • Child Characteristics • Household Characteristics • By Region: • United States • Specific State (E.g. Utah) * Indicates that the state percentage is significantly different from the national percentage at the .10 level.

12. Overall, percent uninsured in Utah is higher than the national average. Among adolescents (age 13-18), percent uninsured is equivalent to the national average. In Utah and the United States as a whole, percent uninsured is much higher among children with no English-speaking parent in the home. Percent uninsured is higher than the national average among the lowest income groups, and equivalent to the national average among the higher income groups * Indicates that the state percentage is significantly different from the national percentage at the .10 level.

13. Table 2: Demographic Characteristics of Children… • By Poverty Level: • All • <200% FPL • <300% FPL • By Insurance Status: • Insured • Uninsured * Indicates significant difference from the mean among the insured at the .10 level

14. In Utah, the uninsured population is primarily composed of Whites and Hispanics. The insured population is primarily composed of Whites. Compared to insured children, a larger share of uninsured children have parents with lower educational attainment The majority of the uninsured (nearly 70%) are low-income (<200% FPL) * Indicates significant difference from the mean among the insured at the .10 level

15. Maryland

16. Overall, percent uninsured in Maryland is lower than the national average. Consistent with national patterns, adolescents (age 13-18) are more likely to be uninsured than younger cohorts. As in Utah and the United States as a whole, children in Maryland with no English-speaking parent in the home have higher rates of uninsurance Percent uninsured is lower than the national average at all income levels. * Indicates that the state percentage is significantly different from the national percentage at the .10 level.

17. In Maryland, Whites and African Americans each make up about a third of the uninsured. As in Utah, compared to insured children, a larger share of uninsured children have parents with lower educational attainment. Though majority of the uninsured (59.9%) in Maryland are low-income (<200% FPL), this share is below the national average (67.3%) and Utah (68.8%). * Indicates significant difference from the mean among the insured at the .10 level

18. Source Uninsured Children: Who Are They and Where Do They Live New national and state estimates from the 2008 American Community Survey. By Victoria Lynch, Samantha Phong, Genevieve Kenney and Juliana Macri of the Urban Institute, August 2010. http://www.rwjf.org/coverage/product.jsp?id=67668 Supported by a grant from the Robert Wood Johnson Foundation. URBAN INSTITUTE

19. TOOLS FOR ENHANCING YOUR OUTREACH EFFORTS: NEW DATA AND NEW MESSAGES Robert Wood Johnson Foundation Lake Research Partners GMMB October 25, 2010

20. Background • Purpose: To learn if attitudes, motivations and barriers to enrolling children in CHIP and Medicaid have shifted since the recession and changes in state programs and enrollment processes (e.g., online applications, etc.) • Focus Groups: With funding by the Robert Wood Johnson Foundation, Lake Research Partners conducted eight focus groups in four cities with low-income parents of uninsured children in July 2010. • Newly uninsured parents between 200-300% of FPL • Latino parents of uninsured children • Parents of teens

21. Key Findings: Cutting to the Chase! • The “old” messages still work – for the most part. • Parents know CHIP/Medicaid and they know the barriers. • Only those newly unemployed or at slightly higher incomes don’t know about the programs. • Latinos are facing extraordinary obstacles to enrollment. • Parents of teens need a little extra info.

22. Key Findings: Best Testing Message In these tough economic times, when so many people have lost their jobs and families are struggling to make ends meet, CHIP and Medicaid can help you cover the cost of health care for your kids and teens, even if it’s temporary. These programs provide low-cost or free health coverage for important health services such as doctor visits, hospitalizations, check-ups, dental and vision care, immunizations, mental health, prescriptions and more. If your situation has recently changed and your child needs health insurance, call 1(877) KIDS-NOW or go to www.InsureKidsNow.gov to find out if they are now eligible.

23. Key Findings:Coverage – Even If It’s Temporary The phrase “even if it’s temporary” works well with most parents of uninsured children, but particularly newly unemployed, who may be applying for the first time or learning about the programs. • CHIP and Medicaid can help you cover the cost of health care for your kids and teens, even if its temporary. • If your situation has recently changed and your child needs health insurance, call X or go to Xto find out if they are now eligible.

24. Key Findings:Families Making Hard Choices • CHIP and Medicaid offer low-cost or free health care for kids so parents don’t have to choose between paying for groceries or paying for health coverage. Framing children’s health care within the context of parents having to make hard choices still works extraordinarily well. It feels real and relevant.

25. Key Findings: Supporting Message Elements • CHIP and Medicaid cover important health services such as doctor visits, hospitalizations, check-ups, dental and vision care, mental health, immunizations, prescriptions and more. • CHIP and Medicaid offer low-cost or free health coverage.

26. Key Findings:Supporting Message Elements • School age children need check-ups and immunizations to attend school and play sports. CHIP and Medicaid makes this affordable. • A family of four earning up to $44,000 a year or more may even qualify. • In an economic downturn with record job losses, it’s not easy to make ends meet. CHIP and Medicaid are affordable health coverage programs for your uninsured children.

27. Barriers: Newly Unemployed Parents • Know much less about the programs • Don’t know where to enroll • Don’t know about the eligibility requirements • Assume they cannot qualify • Hesitate to enroll thinking their situation will change

28. Audience-Specific Messages:Newly Uninsured Parents Many parents who have recently lost their jobs and are now uninsured do not know about the state health coverage programs. • CHIP and Medicaid can help you cover the cost of health care for your kids and teens, even if its temporary. • CHIP and Medicaid offer low-cost or free health coverage. • CHIP and Medicaid cover important health services such as doctor visits, hospitalizations, check-ups, dental and vision care, immunizations, prescriptions and more.

29. Barriers: Latino Parents • Employers and landlords may be unwilling to verify income or their housing situation • Delay applying for CHIP/Medicaid when their child is healthy • Less interested in preventive care • Language and literacy barriers • Families may go to Mexico to address medical and dental needs

30. Audience-Specific Messages: Latino Parents When communicating with Latino parents, address their concerns explicitly and directly. • When you apply only the citizenship status of your child is considered. • You will not be asked to provide any documentation about your citizenship status. Only the citizenship status of your child is considered. • Spanish-speaking operators are available at any time. • Even if you have applied before, laws have changed and you should try again. The application process is easy and you can get assistance applying from a Spanish-speaking representative.

31. Barriers: Parents of Teens • Less urgency to apply for CHIP and Medicaid when the uninsured child is an adolescent or teen • School-based programs provide low-cost and affordable checkups for healthy teens • Less anxious about teen’s health compared to younger children

32. Audience-Specific Messages: Parents of Teens • Accidents happen, whether it’s from playing sports or just being a teen. And just one accident could lead to expensive medical bills, high out-of-pocket costs and even bankruptcy. • Kids and teens who play sports in middle school and high school can get injured which leads to higher ER bills. When talking about CHIP and Medicaid, include “kids and teens.”

33. Message Takeaways:Key Phrases and Concepts • Ease of applying: Applying for CHIP and Medicaid is easier than it used to be. You can apply online, by phone or in person. • Consequences: Uninsured children are less likely to receive care for childhood illnesses, allowing minor health problems to turn into major ones. • Back-to-School Campaign: As you get ready for the new school year, put calling 1(877) KIDS-NOW at the top of your back-to-school checklist.

34. Message Takeaways: Key Phrases and Concepts • Listing services: CHIP and Medicaid cover important health services such as doctor visits, hospitalizations, check-ups, dental and vision care, mental health, immunizations, prescriptions and more. • Affordable coverage: CHIP and Medicaid offer low-cost or free health coverage. • Income levels: A family of four can earn $44,000 a year or moreand their uninsured children can still qualify for CHIP and Medicaid. • Teens: School age children need check-ups and immunizations to attend school and play sports. CHIP and Medicaid makes this affordable.

35. A Few Reminders • Address Barriers Head On • Tell Them What They Get • Skip Health Reform Talk • Promote Applying Online • Keep Materials Simple • Be Choosy With Photos

36. THANKS!

37. Messengers Getting the Messages to the Right People Through the Right People

38. Hispanic/Latino Communities Research Finding: More than half do not have computer or internet at home.

39. Hispanic/Latino Communities Research Finding: More than half do not have computer or internet at home. Messenger: Prominent Latino television media personalities.

40. Hispanic/Latino Communities Practical application: Engage one prominent Latino media personality as spokesperson. If there is no prominent Latino television outlet turn to Latino radio personality.

41. Parents of Teens Research finding: Parents are less anxious about their teenagers needing coverage than coverage for their younger children. Can get injured driving or playing sports—resulting in huge medical bills.

42. Parents of Teens Research finding: Can get injured driving or playing sports—resulting in huge medical bills. Messenger: Coaches

43. Parents of Teens Practical application: Start with outreach to school districts with the largest numbers of eligible children. Work through athletic directors in particular. More to come from Coaches Campaign “Lessons Learned”

44. 200-300% Families Research Findings: Know less about the programs. They need to be informed of value before they will act.

45. 200-300% Families Research Finding: Know less about the programs. They need to be informed of value before they will act. Messenger: Online communities (via Mom blogs & Facebook)

46. 200-300% Families

47. 200-300% Families

48. 200-300% Families

49. 200-300% Families Practical application: Buy or ask for donated permanent ad space on prominent mom blog in state.

50. 200-300% Families Practical application: Buy or ask for donated permanent ad space on prominent mom blog in state. Author monthly blog post on prominent mom blog.