It's not just small employers that have workers relying on public insurance for their children: many people working at large private companies also insure their families through either Medicaid or the Children's Health Insurance Program (CHIP), according to a study by researchers at PolicyLab at Children's Hospital of Philadelphia.

The study, published in Health Affairs, did not determine why parents at such companies cover their kids under public insurance. It could be that the premiums on the employer's plans for family coverage became too expensive, or there were changes in the parent's own health care coverage, the authors speculate.

Still, the study's results “may signal dependent coverage is becoming unaffordable for working families across all sectors — even those we think of as having good benefits — creating greater urgency for policymakers to protect Medicaid and CHIP as a safety net,” says lead author Doug Strane, a PolicyLab researcher.

Most of the children covered under public insurance had parents working for small businesses, with the overall percentage climbing from 53 percent in 2008 to 79 percent in 2016. However, the largest driver of the overall increase in use of Medicaid and CHIP was due to larger numbers of workers at larger employers coming into the programs.

Indeed, of the 8.6 million children in working families who are covered by public insurance, more than 70 percent have a parent who works at a large, private company.

But the biggest single increase of all occurred in moderate-income families earning up to $72,750 a year (for a family of four), in which a parent worked for a small business. Two thirds (64 percent of children) in these families were covered by Medicaid or CHIP in 2016, compared to 21 percent in 2008.

“The landscape of children's health insurance coverage among working families is dramatically shifting, and at a much faster pace than any substantive policy conversations about what high-quality, accessible coverage looks like for all children in the future,” says senior author David Rubin, director of PolicyLab and a pediatrician at CHOP.

“At the very least, we should be protecting Medicaid and CHIP as a safety net for families, while also considering other ways to ensure that dependent coverage remains affordable and provides a robust set of benefits to keep children in working families healthy,” Rubin says.

The data for this study comes from the Medical Expenditures Panel Survey (MEPS), a nationally representative household panel survey. The other authors on the paper were Meredith Matone, Ahaviah Glaser and Genevieve Kanter. Kanter is from the Perelman School of Medicine at the University of Pennsylvania.

Instant Insights /

More employees at large companies relying on public insurance for children

More From HR Executive

Related Stories

Recommended For You