Using evidence to inform policy-makers about health care affordability: The Oregon Healthy Kids experience

In order for children's public health insurance programs to be accessible to uninsured children, the program must also be affordable for the family budget. Significant health policy decisions are made utilizing Federal Poverty Levels (FPLs) without any clear context of how each level differs in terms of regional standards of living and discretionary income. In order to inform the design of a SCHIP expansion program that targets all uninsured children in Oregon, researchers utilized the Economic Policy Institute's web-based Basic Family Budget Calculator and Federal Poverty Guidelines to create a presentation for policy-makers that demonstrated a measure of conservative rural and urban budgets for different family compositions in Oregon and how much discretionary income would be available after paying basic expenses at various FPLs in these areas. Findings suggest that for most Oregonians, there is no discretionary income after meeting basic expenses until over 200% of FPL. Oregon families under 200% FPL face a significant budget shortfall each month and even for families at 300% FPL, it is clear that difficult choices are made concerning where to spend discretionary income to improve family quality of life. This presentation became central to the discussion of affordability in a series of six public meetings across the state, and played a significant role in the Medicaid Advisory Committee's policy recommendations for the Governor's proposal to expand health insurance to all uninsured Oregon Children, Healthy Kids. Regional affordability continues to be a central theme as Healthy Kids moves through the subsequent legislative policy-process.