Employees who go outside the physician network are required to pay very high deductibles.
The program has dropped almost 150,000 children because of budget cuts and higher deductibles.
The advantage of the high deductibles, proponents say, is that they keep the policies cheap.
The cutbacks are taking the form of higher deductibles and lower limits on overall coverage.
For example, many beneficiaries - especially those who use doctors' services but not hospitals - would be required to pay higher deductibles.
Workers at one in six small companies faced even higher deductibles: $1,000 or more.
Often, this takes the form of extra premiums or higher deductibles before insurance kicks in.
"They have to accept extremely high deductibles and settle for less coverage."
As one measure, the insurance companies put into effect higher deductibles for hurricane damage.
And the low premiums compensate for most, if not all, of the policies' higher deductibles.