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The Effects of Marriage, Civil Union, and Domestic Partnership Laws on the Health and Well-being of Children

face difficulties until their deductible is met. Although early studies of HDHPs have shown few adverse effects, these studies have not specifically examined children at different family-income levels. Thus, we believe, the jury is still out on the effects of these plans on children. With respect to our claim that the risks of HDHPs outweigh the benefits, we feel that this is reasonable for 2 reasons: (1) because of the significant out-of-pocket cost differentials compared with conventional health maintenance organization and preferred-provider organization (PPO) plans and (2) the failure of most HDHPs to cover preventive care before the deductible is met. In 2005, according to the Kaiser Family Foundation/Health Research and Educational Trust survey of employers,1 family deductibles were, on average, 5 times higher in HDHPs than in PPOs ($3686 vs $646, respectively). In addition, the same study found that only 30% of workers enrolled in HDHPs are covered for preventive care before the deductible is met. Clearly, families will face greater exposure to financial risk under HDHPs. In addition, if healthier families opt out of PPOs and health maintenance organizations in favor of HDHPs, those left behind will face higher premium prices. We recognize that there is significant variability in service use among children, especially that related to emergency care, hospitalization, surgery, and prescription drug use. However, we do not believe that these problems are best solved through higher family costsharing. Previous research from the Rand Health Experiment2 and more recent experience with the State Children’s Health Insurance Program3 reveals that increasing cost-sharing is associated with reduced use of essential care.