Table 3.

Themes and Subthemes of Barriers to Care Among Low-Income Families

Themes and SubthemesExamples
OHP = Oregon Health Plan (public insurance in Oregon for anyone eligible for Medicaid and children eligible for the Oregon children’s health insurance program).
Getting and keeping health insurance coverage
    Insurance coverage for parents; keep parents healthy to keep kids healthy“Yes. I would like to be on OHP with my 3 girls because if I get sick and can’t go to the doctor, who is going to take care of my girls?!!”
“Yes! I want my OHP health insurance back.… My children have no one else to turn to if I get sick and die because of a lack of health care.”
“I am terrified of losing my OHP coverage.… What good does it do to provide coverage for children without coverage for the parents that care for them? Not much.”
    Unfairness of selective Medicaid coverage“OHP sometimes does not accept adult applications unless they are pregnant. I think that is dumb and unfair. This is racist to men and to women who can’t have kids or have their tubes tied or already have kids and are done having kids. Because of this, it encourages women or teens to get pregnant.”
“The only reason why I can get OHP right now is because I am pregnant. I do not know what I will do after I have the baby.”
“The only reason I get health insurance is because I am currently pregnant. After I have the baby, I will get kicked off.”
    System requirements and age limits“Although we are thankful for OHP, they make it very hard to keep and complicated.”
“I feel it’s not right that a family that is trying to make it in life gets knocked back and down. My 10-year-old son lost his health insurance because I got a 39-cent raise in pay.”
“My 18-year-old daughter has been hospitalized for complications due to anorexia.… She is in desperate need of either a residential program or continuing coverage past her 19th birthday. My daughter was told that OHP is not accepting any new adults.… Is the state of Oregon going to let my daughter die?”
Access to health care services
    Difficulty finding physicians; traveling long distances“Everyone who takes OHP takes no more new patients.”
“There’s never space for my children at the dentist.”
“I’ve heard that it’s hard to find doctors who are accepting new OHP patients. We are generally healthy, so we are risking it.”
“It is impossible to find a dentist that will take OHP. The only one I could find is 3 hours and at least 2 mountain passes away, making getting there almost impossible, especially in the winter.”
“My daughter got a severe sore throat, and absolutely no doctors in Bend would accept OHP. We were referred to the local free clinic but weren’t accepted there because we had OHP. The nearest medical service was in Prineville (40 miles away). And I had no means of transportation.”
Costs associated with medical care
    Unaffordable health care services; services not covered by insurance“I can’t afford to pay co-pays or prescriptions when all I have is $200 child support for rent, gas, diapers, and anything else I need for my apartment like dish soap or toilet paper.”
“We make sure our children get the medical care and medications they need, but sometimes this leaves us without money for other things.”
“I have worked my way off welfare and OHP. I have become eligible for and elected to receive medical insurance through my employer.… I cannot afford to use the insurance.… That is not fair to my child and makes me feel I am failing him as a parent. I’m afraid to drop the coverage because of possible accident or emergency, but we sure could use the money.”
    Unaffordable private insurance premiums“I have to pay a lot out of pocket (for employer-sponsored insurance) and can’t afford it, so my son goes without.”
“We have tried to get assistance but were told we make too much money, but we can’t afford it on our own! Please help us.”
“I was actually relieved when my husband lost his job because it made my son eligible for coverage again. There is no feeling in the world worse than trying to figure out if you should really take an injured child to the doctor or not because of lack of money.”