Research Update: Health Care Expenses from Families’ Budgets to Federal Budgets

By Karina Wagnerman, Georgetown University Center for Children & Families

This week, I am reading studies on how health coverage eases financial pressures on families’ budgets and how children fare in federal expenditures.

Commonwealth Fund’s What’s at Stake: States’ Progress on Health Coverage and Access to Care, 2013–2016

This brief examines the progress made since the ACA, including increases in health coverage for children and adults and increasing access to affordable care.

What it finds

  • Since passage of the ACA, the uninsured rate declined in all states for adults and all but one state for children.
  • Between 2013 and 2016, the share of adults reporting they did not access needed care because of cost decreased, with the largest declines in Medicaid expansion states. The nation also saw a decrease in the share of households where out-of-pocket health care costs was high relative to income.

Why it matters

  • The repeal of the individual mandate is projected to increase the number of uninsured by 13 million by 2027. It will jeopardize the coverage gains from the ACA, including increasing economic insecurity for families if they are no longer able to manage their health care costs.

The Kaiser Family Foundation’s How do Health Care Costs fit into Family Budgets? Snapshots from Medicaid Enrollees

The findings in this brief are based on interviews with Medicaid enrollees. Participants report strained family budgets and that Medicaid helps them access health care in the midst of economic struggles.

What it finds

  • Most Medicaid participants in the study are in a family that is working, but most of these jobs are low-wage and do not offer benefits.
  • Medicaid enrollees use nearly all of their income on basic needs (housing, food, and transportation), have little or no savings, and many have accrued medical debt from being uninsured.
  • Enrollees reported that financial pressures exacerbate health issues and hurt parents’ ability to provide for their children.

Why it matters

  • Medical debt was primarily accrued during times of uninsurance. It negatively affected their credit by limiting their ability to open bank accounts and make important purchases, such as a car.
  • Medicaid enrollees face significant economic insecurity and struggle to pay their monthly bills, but Medicaid coverage allows families to afford health care.

The Urban Institute’s Kids’ Share 2017: Report on Federal Expenditures on Children through 2016 and Future Projections

The analysis reports on federal expenditures devoted to children. The authors’ work is particularly important as policymakers consider spending and tax legislation that may shift the level and composition of public resources invested in children.

What it finds

  • Medicaid is the largest source of federal spending on children. The authors estimate that about one-quarter of federal Medicaid funds, roughly $89 billion, was spent on children under the age of 19.
  • Some of the other spending and tax programs that benefit children include: the EITC, the child tax credit, SNAP, CHIP and TANF.
  • About 10% of the federal budget was spent on children in 2016, and this share has not changed over the last several years. About 24% of the population was under the age of 19 in 2016.

Why it matters

  • By 2020, the federal government will spend more on interest payments on the debt than on children.

Editor’s Note: This post was originally published on the Georgetown University Center for Children & Families’ Say Ahhh! Blog.

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The opinions expressed here are solely those of the individual blog post authors and do not represent the views of Georgetown University, the Center on Health Insurance Reforms, any organization that the author is affiliated with, or the opinions of any other author who publishes on this blog.