The Uninsured: Increasing Coverage

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Many states are trying to expand coverage. Click here for info on state campaigns.

From Families USA:

At a Crossroads: Is Health Coverage Ahead for America? examines how the Senate health reform bill, the Patient Protection and Affordable Care Act, will affect health coverage. It provides state-specific numbers on how many people will gain coverage under the bill, as well as how many people will be uninsured without health reform. (December 2009)

Help for Small Businesses discusses how small businesses face a disadvantage when it comes to providing health insurance and how health reform will help remedy this situation. | Comparing the Small Business Tax Credit Provisions in the House, Senate HELP Committee, and Senate Finance Committee Bills (October 2009)

Medicaid and the Children's Health Insurance Program (CHIP) Soften the Blow during Tough Economic Times discusses how these programs have served as an effective health care safety net for many newly uninsured families, particularly for children. (October 2009)

Health Coverage in the States: How Will Health Reform Help? analyzes how the House health reform bill, America's Affordable Health Choices Act of 2009, would address many of the gaps and problems in the health care systems of specific states. (September-October 2009)

The Essential Benefits Package in the House Health Reform Bill (H.R. 3200) examines the proposed benefits package for the plans in the exchange, discusses the benefits committee and its responsibilities, and outlines issues that advocates should monitor as health reform moves forward. (September 2009)

What's Next for CHIP-Funded Adult Coverage? examines how the Children's Health Insurance Program Reauthorization Act (CHIPRA) changes coverage for parents and for adults without dependent children. (August 2009)

Better Coverage for Children discusses how the health reform legislation that is before Congress will help cover uninsured children, and their families, by making insurance more available and affordable and by expanding Medicaid. (August 2009)

Understanding the Role of the "Exchange" or "Gateway" discusses the new health insurance marketplace, or exchange, that is being developed in national health reform proposals. This short piece looks at how an exchange would work and how it could help middle-class and low-income families find and keep the affordable, quality health care they deserve. (July 2009)

10 Reasons to Support the Health Care Reform Bills provides a quick rundown of the most exciting provisions in the health reform bills pending in Congress, including provisions that will help middle-class and low-income families, small businesses, and seniors and people with disabilities. (July 2009)

Coverage for America: We All Stand to Gain provides state-by-state estimates of how many people will gain coverage under the House health reform bill, known as America's Affordable Health Choices Act of 2009. (July 2009)

Why Is a Public Insurance Plan an Important Part of Health Reform? looks at how a high-quality, affordable public plan will help lower health care costs and add a solid option to the health insurance marketplace. (July 2009)

Why Employers Should Share the Responsibility of Paying for Health Care discusses five reasons why it makes sense to require employers to contribute to the cost of health coverage, known as an "employer responsibility requirement." (June 2009)

Investing in Health Coverage: It Just Makes Sense explores four key reasons why we all have a stake in making sure everyone has health coverage. (June 2009)

Health Care Must Be Affordable for All Families, Regardless of Income presents crucial arguments for why health reform must ensure that health care is truly affordable. It proposes placing reasonable limits on out-of-pocket costs and providing subsidies, especially for those with low and moderate incomes. (April 2009)

Covering More Children, Rewarding Success: State Performance Bonuses discusses the new system of performance bonuses created by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). These bonuses are designed to reward states for enrolling more uninsured low-income children in Medicaid. (April 2009)

Covering the Uninsured in Medicaid describes the critical role Medicaid must play in ensuring coverage for all low-income Americans as part of health care reform. (April 2009)

Getting Covered: Finding Health Insurance When You Lose Your Job is designed to help consumers who've lost their health coverage sort through possible options for new coverage, including COBRA, Medicaid, CHIP, other federal and state programs, and the individual market. (February 2009)

The American Recovery and Reinvestment Act: House Bill Health Coverage Provisions for the Unemployed Are Essential describes key differences in the health coverage provisions in the Senate and House versions of the economic recovery package, namely temporary Medicaid for unemployed workers and COBRA subsidies, and explains why the House provisions are crucial for helping unemployed workers and their families keep health coverage. (February 2009)

Yes We Can...Cover More than 4 Million Uninsured Children shows how many children would gain coverage in all 50 states and the District of Columbia under the CHIP reauthorization bill passed by the House (H.R. 2). (January 2009)

A Shot in the Arm for West Virginia: Increasing Health Coverage for Working Families discusses the state's opportunity to reduce the number of uninsured residents by expanding Medicaid to more parents. The report also examines how expanding parent coverage could boost the state's economy, creating new jobs, wages, and business activity. (January 2009)

Squeezed! Caught between Unemployment Benefits and Health Care Costs examines COBRA coverage and unemployment benefits and finds that, to maintain their employer-based coverage under COBRA, most unemployed workers would have to devote an unrealistically high proportion of their unemployment check to health insurance. (January 2009)

A Painful Recession: States Cut Health Care Safety Net Programs documents one impact of the current recession by examining state cuts in Medicaid and the State Children's Health Insurance Program (CHIP). The report also shows, on a state-by-state basis, how temporarily increasing federal funding for Medicaid can stimulate state economies, increasing business activity, jobs, and wages. (December 2008)

Empty Promise: Searching for Health Insurance in an Unfair Market discusses how the individual health insurance market differs from the employer market and examines what happens to consumers who seek coverage in the individual market. Problems in the individual market include policies that don't provide quality coverage; policies that are very expensive or that cost more than advertised; and the fact that many applicants cannot obtain a policy at any price. (August 2008)

Detour on the Road to Kids Coverage: Administration Creates Roadblocks, So States Seek Alternative Routes examines the current state of children's coverage and finds that, while the Administration's new directive has created roadblocks that stymied state efforts to expand eligibility, it has not stopped states from making progress. (July 2008)

Five Good Reasons to Increase Health Coverage for Parents discusses the reasons why states should strengthen the health and economic security of families by expanding health coverage for parents. (July 2008)

America's Health Care Crisis: Cities on the Front Lines. Families USA surveyed a sample of mayors from across the country on the topics of health care and the uninsured. We found that cities are profoundly affected by the rising number of uninsured and the rising cost of providing coverage for their own employees. This report presents the results of our survey and examines cities’ role in the health care safety net, the impact of the growing number of uninsured on city services, and the ways that state and federal leaders might come together with city leaders to improve health coverage and access for all Americans. (June 2008)

Failing Grades: State Consumer Protections in the Individual Health Insurance Market. Laws protecting consumers purchasing health coverage in the individual market vary across the country. In many states, insurance companies can deny coverage, raise premiums significantly, refuse to cover treatment for certain conditions, and even revoke the coverage of policyholders who have been paying premiums for years. (June 2008)

Reinsurance: A Primer aims to help policymakers and advocates better understand what reinsurance is and how it can make coverage easier to obtain and more affordable. It also identifies some of the benefits of reinsurance to aid lawmakers as they design reinsurance programs to meet the needs of their states. (April 2008)

9 Million Children and Counting: The Administration's Attack on Health Coverage for America's Children examines how the President's two vetoes of CHIP reauthorization legislation, combined with the August 2007 CMS directive, will jeopardize health care for thousands of children. And the President's proposed fiscal year 2009 budget would hurt children's coverage even more. (February 2008)

Universal and Equal: Ensuring Equity in State Health Care Reform States across the country are looking for ways to expand affordable, quality health coverage to more people, but few states have focused specifically on the problem of inequality in health care. This piece presents strategies advocates can use to integrate health equity into larger health reform efforts, as well as a checklist they can use to evaluate their states' proposed expansions. From The Opportunity Agenda and Families USA (January 2008)

Insure Missouri: Too Little, Too Late examines Governor Blunt's proposal to provide health coverage to uninsured Missourians. It finds that the plan's eligibility criteria leave out many low-income uninsured adults, the coverage offered is missing key benefits, the cost-sharing is too high, and the plan is built on shaky financing mechanisms. (January 2008)

Maine's Dirigo Health Reform of 2003 is a thorough examination of the state's health care expansion. It discusses program eligibility, how much people pay for the different types of coverage, what benefits they receive, how the expansion is financed, how it reforms the state's insurance regulations, lessons learned so far, and the future of health reform in Maine. (November 2007)

Healthy Maryland: A Building Block for Maryland's Economy examines the Healthy Maryland Initiative, which will boost the state's economy and extend coverage to more than 100,000 Marylanders who are currently uninsured. (October 2007)

Kids Waiting for Coverage: How Many Are in Your State? provides national and state-by-state estimates of the numbers of uninsured children who could be covered under the House and Senate CHIP reauthorization bills, as well as a discussion of how successful CHIP has been since its enactment in 1997. (September 2007)

Massachusetts Health Reform of 2006 is a thorough examination of the state's far-reaching expansion in health coverage. The report discusses who is eligible, how much enrollees pay for the different types of coverage available, what benefits they receive, who is providing coverage, the individual mandate, and how the reform is being financed. It also discusses what lessons state advocates have learned from the process of getting the legislation passed. (August 2007)

Retail Medical Clinics: Okay in a Pinch, but No Substitute for Real Health Coverage provides an overview of the growing trend of clinics popping up in stores such as Wal-Mart, Target, and CVS. While their convenience is appealing, the tradeoff may be piecemeal services that lack appropriate oversight. Consumers should use such clinics only to supplement care from their regular primary care physician. (August 2007)

Pennsylvania's 2007 Health Care Proposal: Prescription for Pennsylvania examines the governor's plan for comprehensive health reform. This report looks at who is eligible for new coverage, how much they'll pay, what benefits they'll get, and how the state will finance the expansion. It also discusses strengths of the plan, as well as areas of concern. (July 2007)

Healthy Wisconsin: Good Medicine for Wisconsin's Economy analyzes the economic benefits that will accrue to the state if it enacts the "Healthy Wisconsin" proposal, now pending in the legislature. Building on the proposed expansion of BadgerCare Plus, Healthy Wisconsin is designed to provide health coverage to everyone in the state. (July 2007)

Wisconsin's 2007 Health Care Proposal: BadgerCare Plus is a thorough examination of the BadgerCare Plus proposal to expand health coverage. The report discusses who would be eligible, how much enrollees would pay, what benefits enrollees would receive, and how the expansion would be financed. (July 2007)

Confronting Disparities while Reforming Health Care: A Look at Massachusetts examines how state advocates were able to build on expansion efforts and address the host of issues that affect disparities in health and health care. Includes an extensive discussion of lessons that can be learned from the Massachusetts experience. (June 2007)

Written Testimony from Families USA for the House Committee on Insurance, Hearing on Prescription for Pennsylvania (May 30, 2007)

New Jersey's Path Toward Universal Coverage analyzes the state's blueprint for providing health coverage to all of its uninsured residents. (May 2007)

Illinois Covered Proposal examines the state's most recent coverage expansion effort, which focuses on adults between the ages of 19 and 64. (May 2007)

Getting "Illinois Covered"—It Makes Fiscal Sense discusses why expanding health coverage through Governor Blagojevich's proposed program is a sound investment for the state. (April 2007)

The Healthy Maryland Initiative: Good for Maryland's Economy discusses how this new initiative will expand coverage to uninsured Marylanders and stimulate the state's economy. (March 2007)

Vermont's Health Reform Laws discusses the basics of the state's two new laws, known as "Catamount Health." The piece also examines how Catamount Health will be financed, how the laws build on existing health coverage programs, and pros and cons of the laws. (December 2006)

Illinois' All Kids: A Step in the Right Direction discusses this new children's coverage program, including eligibility, benefits, cost-sharing, and how the program is financed. (October 2006)

Employers Should Pay Their Fair Share for Health Care explains what employer responsibility legislation is and discusses its benefits and potential drawbacks using examples of states that have implemented such legislation. (September 2006)

Vermont's Health Reform Law: What Does Vermont's 2006 Catamount Health Legislation Do? (September 2006)

H.R. 2355, The Health Care Choice Act: The Wrong Prescription for America's Health Care Needs discusses how this legislation, sponsored by Rep. Shadegg and favored by the Administration, would undermine state laws designed to protect health care consumers. (August 2006)

TABOR: A Wolf in Sheep's Clothing examines the effects that so-called "Taxpayer Bill of Rights" (TABOR) state amendments will have on health care. It finds that these anti-consumer conservative initiatives will cripple a state's ability to respond to residents' needs or unforeseen disasters and will result in cuts to essential health care programs, including Medicaid. (August 2006)

Making History: Maryland's Fair Share Health Care Law discusses how the law works, who it affects, and the key strategies advocates used to get the law passed. It also includes a timeline of critical events. (May 2006)

High-Risk Health Insurance Pools provides answers to key questions about high-risk pools, including who they help and how they are financed. The report also includes a list of questions consumers should ask if they are considering joining a high-risk pool, as well as a checklist for advocates. (May 2006)

Statement: Massachusetts Becomes First State to Achieve Near-Universal Health Coverage (April 18, 2006)

Statement: Massachusetts Legislature Passes Landmark Health Coverage Expansion (April 4, 2006)

A 10-Foot Rope for a 40-Foot Hole: Tax Credits for the Uninsured, 2004 Update
Several policy makers have proposed the enactment of tax credits to help the uninsured purchase coverage. To find out what such a tax credit would mean for uninsured, low-income people, Families USA gathered and analyzed information about insurance plans offered in 50 states and DC. (November 2004)

Ideas that Work: Expanding Health Coverage for Workers
A Tool Kit for those who want to build a state-based health coverage initiative based on employer-provided insurance. Includes case studies of California and Hawaii, a "decision guide," and tables with state-by-state data about employment and insurance coverage. (October 2004)

Health Issues 2004: A forum to discuss America's health care crisis, chaired by Senator Edward Kennedy (July 2004)

One in Three: Non-Elderly Americans Without Health Insurance, 2002-2003
How many people under age 65 were without health insurance for all or part of 2002 and 2003? The report includes national- and state-level data, including data broken down according to work status, income level, race and Hispanic origin, age, and region of the country. The findings are based exclusively on data projections drawn from Census Bureau information. | en Español | Individual State Fact Sheets (June 2004)

Working without a Net: The Health Care Safety Net Still Leaves Millions of Low-Income Workers Uninsured | en Español For millions of low-income Americans, the health care safety net is a myth -- nearly 14 million low-income adults are uninsured and ineligible for public health insurance programs. This Special Report provides national and state-by-state data on the numbers of low-income parents and adults without children who are falling through the holes in our nation's health care safety net. (April 2004)

To read about the President's New Medicare Proposals in His Budget for Fiscal Year 2005, See The Bush Administration's Fiscal Year 2005 Budget: Analysis of Key Health Care Provisions (February 4, 2004)

Testimony by Families USA Executive Director Ron Pollack before the U.S. Senate on Covering the Uninsured (January 6, 2004)

The Trade Act Health Insurance Subsidy: An Update from the States
This Issue Brief analyzes the implementation of the new subsidy offered by the Trade Adjustment Assistance Reform Act of 2002 (TAARA) and suggests changes that might strengthen the existing program. (December 2003)

What's Wrong with Tax-Free Savings Accounts for Health Care?
Tax-free personal savings accounts for health care have become the latest cure-all for the problems facing our health care system. This Issue Brief uses a hypothetical company to examine how such accounts undermine the pooling of risk--the basis for insurance. (November 2003)

A Shelter in the Storm: How a Subsidy Could Help Unemployed Workers Get Health Insurance (October 2003)

Congressman Snyder Bill Helps Cover Uninsured Young Adults (October 2003)

Tax-Free Savings Accounts for Medical Expenses: A Tax Cut Masquerading as Help to the Uninsured This Issue Brief discusses Health Savings Accounts and Health Savings Security Accounts, two kinds of personal savings accounts that were created by a bill attached to the House Republican Medicare prescription drug legislation. (July 2003)

Individual Tax Credits Do Not Work. This fact sheet discusses why the tax credits proposed by the Bush Administration wouldn't help people purchase health coverage in the individual market. (May 2003)

The Health Insurance Tax Credit in the Trade Adjustment Assistance Reform Act of 2002 (April 2003)

The Bush Administration's Fiscal Year 2004 Budget: Analysis of Key Health Care Provisions (February 7, 2003)

Statement: The President's Budget Shortchanges America's Health Care Needs (February 3, 2003)

Families USA's Testimony at the House Hearing on Expanding Access to Quality Health Care: Solutions for the Uninsured (July 9, 2002)

Press Release] [State Charts] (May 2002)

Medical Savings Accounts: This updated fact sheet defines MSAs, explains how they work, and discusses why they shouldn't be expanded. (April 2002)

Families USA Summary of the Health Provisions in the Bush Administration's FY03 Budget (February 5, 2002)

Bush's Budget Outlines a Dangerous Path for America's Health Care: (Families USA Statement on Administration's 2003 Budget (February 4, 2002)

Families USA Critique of the eHealthInsurance Analysis of the Individual Market
President Bush and many members of Congress have pressed hard for the use of individual tax credits as a way of helping uninsured people buy health insurance. The Internet insurance company eHealthInsurance.com has also been a strong proponent of this strategy and has issued a report that is being used widely on Capitol Hill to support individual tax credits. Families USA has analyzed this report and found several major flaws, which we detail in this critique. (February 2002)

Special Report on Need for COBRA Subsidy in Stimulus Package (December 2001)

Key Facts on Providing Health Insurance for Newly Unemployed Workers (October 15, 2001)

The Bush Administration's Health Proposals in the Economic Stimulus Package (October 8, 2001)

Response to Bush Health Proposal in the Stimulus Package - statement by Ron Pollack, executive director of Families USA, concerning President Bush's health care proposal in the economic stimulus package. (October 4, 2001)

A 10-Foot Rope for a 40-Foot Hole: Tax Credits for the Uninsured. Individual Tax Credits Will Not Expand Health Coverage For America's Uninsured. Press Release | Kennedy and Snowe to Unveil Bipartisan Family Care Legislation - Support Family Care Legislation of 2001.

Congressional Budget Resolution Includes Significant Amount for the Uninsured
Statement by Ron Pollack, Executive Director of Families USA. (May 3, 2001)

The Federal Budget: Funds for Uninsured Working Families A Families USA Health Policy Memo about the federal budget and the need to expand health coverage. It also focuses on the tax credit option. (February 23, 2001)

Challenges and Options for Increasing the Number of Americans with Health Insurance This new Commonwealth Fund report presents an overview of 10 papers, each of which explores a different option for expanding coverage to uninsured workers, their families, and people between jobs. Despite a prolonged economic expansion, some 43 million Americans, including 36 million in working families, are uninsured. With more than three-quarters of the uninsured living on incomes below $35,000 per year, affordability is a key barrier to coverage. (December 2000)

Finding Common Ground for Expanded Health Coverage to The Uninsured: Families USA joins the Health Insurance Association of America, and the American Hospital Association in an effort to expand health coverage for a substantial portion of America's 43 million uninsured. (November 20, 2000)

The Health Action Newsletter: this popular newsletter provides advocates with the latest information on managed care, CHIP, Medicare and more!

Five Good Reasons for States to Expand Family Coverage: this fact sheet outlines reasons to expand the Medicaid and CHIP programs to include working parents and adults. (April, 2000)

Families USA's Response to Governor Bush's Health Plan Families USA Executive Director Ron Pollack issues a statement describing Bush's health plan as "A Trivial Response to a Serious Problem." (April 11, 2000)

President Clinton's FY2000 Budget Families USA's legislative department provides this overview of the President's budget proposals for Medicaid, CHIP and Medicare. (February, 1999)

Family Coverage Options Under Chip, The State Children's Health Insurance Program
This report discusses the use of CHIP funds and other resources in covering the costs of health insurance for uninsured families. (August, 1998)

Learn about the Economic Stimulus Plan:

• The Health Coverage Dispute in the Economic Stimulus Package
• Special Report on How Senate Finance Committee Economic Stimulus Package Would Help Californians
• New Data Indicate Nearly 1 million Lost Health Insurance and Jobs Since March
• Special Report on Need for COBRA Subsidy in Stimulus Package
• Families USA Supports the Senate Finance Committee's Health Coverage Provisions in the Economic Stimulus Bill
• The Bush Administration's Health Proposals in the Economic Stimulus Package
• Response to Bush Health Proposal in the Stimulus Package
• Key Facts on Providing Health Insurance for Newly Unemployed Workers

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From the Alliance for Health Reform:

Health Insurance Exchanges: See How They Run is a webcast that looks at insurance exchanges and examines the following questions: What is meant by a health insurance exchange, and how might it work? Who would be allowed to seek coverage through the exchange? What rules would govern the conduct of plans offering coverage? What’s in it for the consumer? (May 2009)

From the Blue Cross and Blue Shield Association:

State Legislative Health Care Issues The Blue Cross and Blue Shield Association has released its 9th annual survey of state legislative activity focused on health insurance access and regulation. The three legislative trends consisted of increasing health plan regulation, expanding access for the uninsured, and reining in the cost of prescription drugs. Of the three trends, the most popular initiative was expanding health insurance access for certain populations, including children in low-income families and seniors lacking drug coverage. (June 2001)

From the California Health Care Foundation:

The California Health Care Foundation The Foundation's mission is to expand access to affordable, quality health care for underserved individuals and communities and to promote fundamental improvements in the health status of the people of California. The Foundation's Coverage Expansion Resource Center offers a framework for state and national policy makers to objectively compare attributes and trade-offs of expansion proposals and the status quo.

From the Campaign for America’s Future:

How to Structure a “Play-or-Pay” Requirement on Employers examines not only how to structure an employer coverage mandate, but also the economic and political impacts of such a mandate, as part of health reform. In addition, it offers recommendations for navigating the political issues raised by such a requirement. The authors conclude that the potential negative effects of instituting a mandate are modest and would be outweighed by the benefits. (June 2009)

Healthy Competition: How to Structure Public Health Insurance Plan Choice to Ensure Risk- Sharing, Cost Control and Quality Improvement examines the debate over the effectiveness of the public plan option in health reform. It also suggests the most effective ways to implement a successful public plan model. (April 2009)

From the Center for Studying Health System Change:

Massachusetts Health Reform: High Costs and Expanding Expectations May Weaken Employer Support finds that, while the number of uninsured has declined significantly since the enactment of the state’s landmark health expansion, the high cost of the reform has prompted the state to seek additional financial support from stakeholders, including employers. Improved access to the individual insurance market, the availability of state-subsidized coverage, and the costs of increased employee take-up of employer-sponsored coverage and rising premiums could weaken employers’ motivation and ability to provide coverage. (October 2008)

Relief, Restoration, and Reform: Economic Upturn Yields Modest and Uneven Health Returns reports that recent gains in health coverage, such as increased numbers of low-income adults obtaining coverage, face challenges as the economy continues its downturn. State and local governments will likely cut public health programs as they face recessions. (January 2008)

The Center for Studying Health System Change has issued a new study, titled Physicians Pulling Back from Charity Care, that documents the recent drop in the percentage of physicians providing charity care. The findings are based on the Community Tracking Study Physician Survey of more than 12,000 physicians. The authors conclude that reduced physician participation in charity care will hurt the medically indigent if, as projected, growth in physician supply slows and the number of uninsured rises along with escalating health care costs. (August 2001)

From the Center on Budget and Policy Priorities:

Designing Benefit Standards for a Health Insurance Exchange explains that, in any exchange that is created as part of health reform, it is crucial to establish benefit standards so that all plans cover a comprehensive range of services, thereby ensuring that individuals and small businesses have a choice of affordable, comprehensive plans. These benefit standards would protect people with particular medical conditions from facing excessive costs, and they would better enable consumers to compare plans based on price and quality. (May 2009)

Ensuring Affordable Health Coverage and Health Care Services in an Insurance Exchange finds that any health reform proposal that requires everyone to obtain health insurance must establish mechanisms to make health coverage and health care affordable. It also identifies four key components that any successful exchange should have: minimum standards for benefit packages, limits on the degree of variation in different benefit packages, limits on the number of different plan choices, and a requirement that insurers in the exchange offer the full range of benefit packages. (May 2009)

Rules of the Road: How an Insurance Exchange Can Pool Risk and Protect Enrollees finds that a strong exchange can greatly reduce the problems many people currently face when they must obtain coverage on their own without the help of an employer. It then lays out four key components of an efficient insurance exchange, including minimum standards for the benefits packages offered and a limit on the number of different benefit packages. (April 2009)

Improving Medicaid as Part of Building on the Current System to Achieve Universal Coverage reports that as the source of comprehensive, affordable coverage, Medicaid can serve as one model for health care reform. The report discusses ways that policymakers can improve the program, including integrating Medicaid into broader efforts to increase the cost-effectiveness of health care and facilitating enrollment by modernizing eligibility rules and procedures. (February 2009)

Health Savings Accounts (HSAs) are accounts in which individuals who have high-deductible health insurance can save money to pay for out-of-pocket health expenses. The Bush Administration has touted HSAs as a solution to covering the uninsured. A Brief Overview of the Major Flaws With Health Savings Accounts explains why HSAs might not be such a good idea after all. (April 2006)

As part of its fiscal year 2005 budget, the Administration again proposed providing a refundable tax credit to individuals and families for the purchase of health insurance in the individual market. Administration's Proposed Tax Credit for the Purchase of Health Insurance Could Weaken Employer-Based Health Insurance discusses the potential drawbacks of such a plan. (April 2004)

Likely Medical Savings Account Amendment to Patients' Bill of Rights Could Drive Up the Price of Health Insurance Premiums and Increase the Number of Uninsured - defines MSAs (Medical Savings Accounts), describes the MSA demonstration, and discusses the negative effects of more widespread use of MSAs.

Expanding Medicaid coverage to low-income parents reduces number of uninsured children, new research finds. Parental Coverage Also Improves Utilization, Does Not Significantly Erode Employer Insurance. (September 5, 2000)

Assuring That Eligible Families Receive Medicaid When TANF Assistance is Denied or Terminated (November, 1998)

Taking the Next Step: States Can Now Expand Health Coverage to Low-Income Working Parents Through Medicaid (August, 1998)

From the Centers for Disease Control:

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2007 finds that lack of health coverage was greatest in the South and West, with 30 percent of adults under age 65 and 18 percent of children lacking coverage. The brief also provides state-specific estimates for the uninsured and estimates for those enrolled in high-deductible health plans. (June 2008)

From the Children’s Partnership and the Kaiser Commission on Medicaid and the Uninsured

Why Express Lane Eligibility Makes Sense for States and Low-Income Families explains how Express Lane Eligibility would help states streamline enrollment and renewal of children in Medicaid and CHIP by coordinating across programs. The brief highlights the potential benefits of an Express Lane Eligibility initiative, including increasing access to care for low-income children, making coverage more stable, and reducing administrative costs. (October 2009)

From the Citizens’ Health Care Working Group:

Health Care that Works for All Americans is a set of six recommendations for health care reform addressed to Congress and the President. The first recommendation suggests establishing a public policy ensuring that all Americans have affordable health care. (October 2007)

Health Care that Works for All Americans: Health Report to the American People outlines current health care policy issues and formulates recommendations based on the input of thousands of Americans who participated in community meetings held across the country. The report offers insight into many health care issues, including rising costs, quality shortcomings, and access problems. (September 2006)

From the Colorado Consumer Health Initiative:

Connecting Care & Health for Colorado: A Proposal to Expand State Coverage by the Colorado Consumer Health Initiative is a state proposal that addresses the problems of the uninsured, the underinsured, and the high cost of health care to individuals and businesses in Colorado designed in collaboration with Community Catalyst and Families USA (April 2007)

From the Commonwealth Fund:

Out of Options: Why So Many Workers in Small Businesses Lack Affordable Health Insurance, and How Health Care Reform Can Help examines why small businesses often have more difficulty offering their employees health insurance, as well as how the economic downturn has intensified the problem. The brief also outlines how measures in the health reform proposals, such as the creation of an exchange and tax credits for small businesses, could help small businesses and their employees gain access to affordable, comprehensive coverage. (September 2009)

Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2009 Update explains why young people ages 19-29 continue to be one of the largest and fastest-growing groups without health insurance and the possible repercussions of this trend. The brief also suggests policy reforms that could help young adults stay insured as they become more independent. (August 2009)

Fork in the Road: Alternative Paths to a High Performance U.S. Health System compares three different health reform scenarios: 1) one that includes a public plan option in which health care providers would be paid at rates midway between Medicare rates and private plan rates, 2) one that includes a public plan option that links payments more closely to Medicare rates, and 3) one that includes no public plan (instead relying exclusively on private plans). Cumulative health system savings would range from $3 trillion under option 1 to $2 trillion for option 2 to $1.2 trillion for a purely private plan approach under option 3. (June 2009)

Setting a National Minimum Standard for Health Benefits: How Do State Benefit Mandates Compare with Benefits in Large-Group Plans? compares state-mandated benefits with the services and providers covered under the Federal Employees Health Benefits Program (FEHBP) Blue Cross and Blue Shield standard benefit package. With few exceptions, the FEHBP plan either meets or exceeds the benefits that state mandates require. Under a national standard, states would still have the option of providing other benefits above the national standard. (June 2009)

How Have Employers Responded to Health Reform in Massachusetts? Employees’ Views at the End of One Year reveals that employers have neither dropped coverage nor restricted eligibility for coverage in the state’s first year of health reform. Despite initial concern from critics, researchers have found that employers made no changes to the scope of benefits, range of provider choices, or quality of care available under their plans. (October 2008)

On the Road to Universal Coverage: Impacts of Reform in Massachusetts at One Year found that in the first year, the rate of the uninsured working-age adults in the state dropped by almost half, from 13 percent to 7 percent. In addition, the study found improvements in access to care, particularly among low-income adults, and fewer adults with high out-of-pocket costs and medical bill problems. (June 2008)

Who Pays for Health Care When Workers Are Uninsured? reports that holes in employer-based coverage generate public costs in the form of public insurance programs or uncompensated care programs that cover care that would otherwise be paid for through insurance. This report quantifies those costs and finds that, in 2004, uninsured and publicly insured workers cost taxpayers $45 billion. (May 2008)

Health Policy Reform: Beyond the 2008 Elections is designed to provide journalists with a context for understanding the fundamental problems that plague our health system, as well as policy options for addressing these problems. It points out that, while expanding access to health coverage is the single most important step to achieving a better system, there are a number of other policy steps that need to happen, from speeding the adoption of emerging information technologies to building new payment mechanisms that reward quality instead of quantity. (March 2008)

Overburdened and Overwhelmed: The Struggles of Communities with High Medical Cost Burdens: The number of people with potentially high medical cost burdens varies widely across the nation. Some of these people lack insurance, while others are insured but are paying a high portion of their income to get that coverage. Federal support will be critical to addressing this problem. (November 2007)

Health savings accounts (HSAs) and high-deductible health plans (HDHPs) have been promoted by the Administration as part of the solution for the problems facing the U.S. health care system. Health Savings Accounts: Why They Won’t Cure What Ails U.S. Health Care presents expert testimony that encouraging Americans to join HSAs will only exacerbate the nation’s health care woes. Current evidence shows that HSAs suffer from low enrollment, low satisfaction, high out-of-pocket costs, and cost-related access problems. (June 2006)

Health Insurance for All: What We Can Learn from Massachusetts argues that Massachusetts’ new law offers lessons for every state. (May 2006)

Americans between the ages of 19 and 29 represent the largest and fastest-growing segment of the population without health coverage. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help argues that there are several ways to extend coverage to young adults—and prevent others from losing it. These include extending eligibility for Medicaid and SCHIP beyond age 18; extending eligibility for dependents beyond age 18 or 19 regardless of student status; and ensuring that colleges and universities require full- and part-time students to have insurance. (May 2006)

Nonstandard workers—those employed on a part-time, temporary, or contractual basis—are far more likely than regular, full-time employees to lack health care coverage, experience gaps in their coverage, or depend on their spouse's employer coverage or on public insurance programs, according to On the Fringe: The Substandard Benefits of Workers in Part-Time, Temporary, and Contract Jobs. The report estimates that in 2001, only 21 percent of nonstandard workers received health insurance through their employers, compared to 74 percent of standard workers.  The report also offers policy options for reaching these uninsured, nonstandard workers and their families. (December 2005)

Employer-based health insurance provides the majority of U.S. workers with access to health care and protection against devastating financial losses. Millions of workers, however, do not receive health benefits from their employers, and few sources of affordable coverage exist outside the employer-based system. Wages, Health Benefits, and Workers' Health found a deep divide in the U.S. labor force and an urgent need for expanding access to comprehensive and affordable coverage to workers and their families. (October 2004)

Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the population without health coverage. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help contends that jobs available to young adults often pay poorly or are temporary and typically do not provide health coverage. This Issue Brief assesses the scope of the health insurance problem facing young adults, its causes, implications, and what can be done about it. (May 2003)

Health Insurance Tax Credits: Will They Work for Women? Examines premium and benefit quotes for health insurance plans in 25 cities, finds that tax credit proposals within the range of those proposed by the Administration would not be large enough to make health coverage affordable to women with low incomes. According to the study, tax credits of $1,000 or $1,500 would leave even healthy young women with a choice of plans with deductibles that were high relative to their incomes, if such plans were available at all. For older women, no plans with premiums in this range were available in most cities. (December 2002)

Staying Covered: The Importance of Retaining Health Insurance for Low-Income Families argues that improving insurance retention is both a cost-effective and under-appreciated way to increase the number of people with health coverage. For example, the number of uninsured, low-income children would decline by almost 40 percent, and the number of uninsured adults would decline by more than one-quarter, if every person with public or private coverage at the beginning of a given year retained it for the next 12 months. The authors recommend strategies that federal and state governments and employers can use to improve retention. (December 2002)

Assessing State Strategies for Health Coverage Expansion: Case Studies of Oregon, Rhode Island, New Jersey, and Georgia profiles several examples of innovative state programs aimed at increasing the number of residents with health coverage. It analyzes elements common to the states' successes, including strong leadership and commitment, seamless coverage for disparate groups, and involving providers and consumer advocates in program design. (November 2002)

For Bare-Bones Health Plans: Are They Worth the Money? Researchers developed several alternative insurance policies that would cost 30 percent less than a current basic benefit plan and examined the implications of these policies for purchasers. The authors conclude that, although bare bones-policies are ostensibly meant to make insurance more affordable for low-income consumers, out-of-pocket costs could easily exceed 10 percent of income for low-wage people. Also, such people could face catastrophic medical costs well in excess of their annual income. (May 2002)

Are Tax Credits Alone the Solution to Affordable Health Insurance? Comparing Individual and Group Insurance Costs in 17 U.S. Markets examines group and individual insurance premiums in 16 metropolitan and one rural area for individual plans roughly equivalent to the average benefits in the employer group market. The report also assesses the affordability of individual insurance premiums for men and women ages 27 and 55 with no preexisting medical conditions whose annual income is 200 percent of the federal poverty level. The authors conclude that "... if policymakers want to make health insurance affordable to women and older or less-healthy adults, a $1,500 tax credit will not ... protect these people from incurring catastrophic out-of-pocket expenses." (May 2002)

Insuring the Uninsurable: An Overview of State High-Risk Health Insurance Pools is a new report from The Commonwealth Fund by researchers at Mathematica Policy Research. The report concludes that high-risk insurance pools, currently available in 29 states, offer only limited help for those who've been denied private health coverage because of pre-existing medical conditions or are Medicare beneficiaries in need of supplemental insurance. The authors found that high premiums, deductibles, and copayments make high-risk pools unaffordable for people with serious medical conditions, and that waiting periods for those with certain medical conditions also keep enrollment rates low. (August 2001)

Expanding Employment-Based Health Coverage: Lessons from Six State and Local Programs This report from the Commonwealth Fund provides an in-depth look at selected state and local programs. A companion piece to the Fund's "State and Local Initiatives to Enhance Health Coverage for the Working Uninsured" study, this report describes six state and local programs in greater detail.

State and Local Initiatives to Enhance Health Coverage for the Working Uninsured This Commonwealth Fund study summarizes 21 state and local programs designed to help the 24 million American workers and their family members who lack health insurance. These families earn too much to qualify for public insurance programs or work for low wages at small companies that do not offer coverage. (November 2000)

Employer Coverage: Can't Live Without It. Health Care for Everyone: Is It Possible? This PowerPoint presentation by president Karen Davis to the Massachusetts Medical Society Conference explores options for achieving health care coverage for all and concludes that the country can't achieve universal coverage without employer-sponsored coverage.

ERISA and State Health Care Access Initiatives: Opportunities and Obstacles This study examines the potential of states to expand health coverage incrementally should the federal government decide to reform the Employee Retirement Income Security Act (ERISA) of 1974, which regulates employee benefit programs such as job-based health plans. ERISA contains a broad preemption clause that supersedes state laws relating to private sector, employer-sponsored plans, which can limit states' attempts to expand health care access through workplace coverage. According to the report, clarifying ERISA would help states promote efforts to get more people insured.

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From the Commonwealth Fund and the California HealthCare Foundation:

COBRA Subsidies for Laid-Off Workers: An Initial Report Card indicates that enrollment in COBRA coverage has increased substantially, and reports show that most eligible people have heard about the subsidy. Unfortunately, many eligible people still can't afford COBRA coverage. In order to further increase enrollment, Congress should consider raising subsidies and further simplifying enrollment procedures. (December 2009)

From Community Catalyst:

Expanding Coverage for Dependents finds that young adults are one of the fastest-growing groups without health insurance. The report proposes changing state laws to allow young people to remain on their parents’ health insurance plans beyond age 18. However, most states continue to place restrictions on which dependents are eligible for coverage by limiting it to those who are students, who live with their parents, or who do not have access to other forms of insurance. (February 2009)

Massachusetts Health Reform: What It Does; How It Was Done; Challenges Ahead provides a comprehensive description of the Massachusetts health coverage plan, including an analysis of its strengths and weaknesses. (April 2006)

From Community Voices:

Community-Based Health Plans for the Uninsured: Expanding Access, Enhancing Dignity 
A report released by Community Voices and prepared by the Economic and Social Research Institute, focuses on community-based initiatives in five Community Voices learning laboratories around the country. To develop ways of providing health insurance for people who are not covered by either government programs or private insurance, these programs enroll uninsured individuals and families into organized health plans that provide a designated set of benefits. The sites featured are: Alameda County, California; Bernalillo County, New Mexico; El Paso, Texas; Ingham County, Michigan; and North Carolina. (November 2001)

Mental Health Care Policy Community Voices: Health Care for the Underserved has published a report that provides overviews of barriers to access and use of behavioral health services, the financing of mental health services, and the coordination of such services. It also presents new policy solutions aimed at expanding access to care and providing early intervention services. (May 2001)

From Consumer's Union:

Blueprint for Fair Share Health Care discusses past efforts to enact health care reform, and offers principles to guide future efforts. (May, 1999)

From the Council of Economic Advisers:

The Case for Health Reform provides an overview of how health care affects the economy and a forecast of where we will end up in the absence of reform that includes expanded coverage. If the annual rate of growth of health care spending is not reduced, the number of uninsured could rise to 72 million by the year 2040. (June 2009)

From the Employee Benefit Research Institute (EBRI):

ERISA Pre-emption: Implications for Health Reform and Coverage provides an overview of state and local attempts at comprehensive health insurance reform and finds that ERISA limits states’ ability to carry out these reforms. For example, ERISA prevents states from establishing minimum levels of coverage for employer-based plans and limits their ability to fund health insurance subsidies for low-income adults through a tax. (February 2008)

Severing the Link Between Health Insurance and Employment: What Happens if Employers Stop Offering Health Benefits? (May, 1999)

From Georgetown University’s Center for Children and Families:

The Last Piece of the Puzzle: Providing High-Quality, Affordable Health Coverage to All Children through National Health Reform provides a blueprint of what children and families need from health reform, including an overview of where gaps in children’s coverage remain. It also includes recommendations regarding the key challenges that must be addressed in order to complete the puzzle. (May 2009)

From the Georgetown University Health Policy Institute Center for Children and Families and Lake Research Partners:

Election Survey Finds Broad Support for the State Children's Health Insurance Program (SCHIP) notes that more than eight in 10 voters favor increasing spending on the SCHIP. This summary outlines the results of the survey and describes the outcomes of other public opinion surveys about health coverage for children. (December 2006)

From Health Affairs:

Uninsured Adults with Chronic Conditions or Disabilities: Gaps in Public Insurance Programs discusses why an increasingly large number of working-age adults with low incomes and chronic health conditions or disabilities lack insurance. The brief argues that narrow eligibility requirements for Medicaid often exclude this vulnerable group. Expanding these requirements to ensure greater access to coverage should be a priority in national health reform. (October 2009) Subscription Required

Implementing Health Care Reform in Massachusetts: Strategic Lessons Learned emphasizes that extensive reform requires a sequence of changes. It also points out that there is a political advantage in conceptualizing comprehensive health reform as a continuous campaign. (May 2009) Subscription Required

Will Americans Support the Individual Mandate? presents national public opinion data and found that, on its own, an individual mandate does not have broad support across a politically diverse group of participants. The study did find, however, that policy makers who choose to pursue an individual mandate may expand their base of supporters by incorporating it into a "shared-responsibility" plan that includes requirements for employers, government, and insurers. (April 2009)

Willingness to Pay for Cross-Border Health Insurance between the United States and Mexico estimates the demand for a health insurance plan that would include preventive and ambulatory care in the U.S. and comprehensive care in Mexico. More than 60 percent of the surveyed population seemed interested in the product, and more than half were willing to pay between $75 and $125 a month if health officials offered the program in public hospitals. (February 2008)

A Progress Report on State Health Access Reform describes specific state advances in health coverage, including expansions for uninsured children and adults, regulating the individual insurance market, and employer mandates. However, the findings do not predict how long these changes will last. (January 2008)

Employers’ Views on Incremental Measures to Expand Health Coverage examines employers’ views on the importance of health benefits and their perspective on policies aimed at improving employees’ access to coverage and quality care. Employers of all sizes hold a positive view of the value of health benefits in attracting and retaining workers and in improving workers’ health and productivity. (A subscription is necessary to view the full article.) (November 2006)

The nation's inability and unwillingness to ensure equal access to high-quality health care is fueling a widening rift between rich and poor, according to A Widening Rift in Access and Quality: Growing Evidence of Economic Disparities. The report states that most of the investments and initiatives that are designed to expand coverage are occurring in more affluent areas where people have employer-based health care coverage and not in low-income community where people are more likely to rely on Medicaid. (December 2005)

"Individual Insurance: How Much Financial Protection Does It Provide?" presents the results of a study that compared individual health insurance with employer-sponsored plans and estimated out-of-pocket spending for people with group and individual insurance. Among the findings is that cost-sharing in individual plans is much greater than it is in group plans, while covered benefits are more meager. (April 17, 2002)

From the Health Care Financing Administration (HCFA):

Supporting Families in Transition: A Guide to Expanding Health Coverage in the Post-Welfare Reform World. Also posted is aletter to TANF Administrators, State Medicaid Directors, and CHIP Directors regarding the guide. (March, 1999)

The State Medicaid Directors and TANF Administrators Letter advises them to seek out innovative ways to coordinate the administration of and eligibility for their TANF and Medicaid programs.

From the Institute of Medicine:

Insuring America's Health: Principles and Recommendations Last in a series on the consequences of being uninsured, this report calls for universal health coverage by 2010. The report offers five guiding principles by which all proposals for expanding coverage should be judged: any plan should be universal; continuous; affordable to individuals and families; affordable and sustainable to society; and it should promote access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable. (January 2004)

From the Kaiser Commission on Medicaid and the Uninsured:

The Extension of the COBRA Subsidy: An Update reviews the COBRA subsidy and key changes made since its extension in December 2009. The brief looks at the options available for people who may have dropped coverage in anticipation of the end of the subsidy or who paid the full premium after their nine months of receiving the subsidy expired. (December 2009)

CHIP Tips: New Federal Funding Available to Cover Immigrant Children and Pregnant Women highlights new opportunities for covering children under the Children’s Health Insurance Program Reauthorization Act (CHIPRA). The brief examines how the new option works and provides information about eligibility requirements. In addition, it explains the choices states face when deciding whether to pursue this option. (July 2009)

Side-by-Side Comparison of Major Health Care Reform Proposals compares the leading reform proposals across a number of key characteristics, including expansion of public programs, benefit design, and changes to private insurance. The side-by-side includes details from H.R. 3200, the America’s Affordable Health Choices Act of 2009, along with proposals from the Senate Finance Committee (based on press releases from the committee) and the Senate HELP Committee. (July 2009)

Medicaid as a Platform for Broader Health Reform: Supporting High-Need and Low-Income Populations summarizes the problems that low-income individuals face in today's health care system and explores policy options for expanding Medicaid to cover more of this population as a base for broader health reform efforts. The report finds that Medicaid can provide a strong foundation that can help ensure the success of broader reform efforts by maintaining coverage for the poor and sick while providing a vehicle to reach low-income adults. (May 2009)

The Coverage and Cost Impacts of Expanding Medicaid analyzes several options for covering more low-income uninsured people through Medicaid. It also explains how reductions in spending by firms and individuals for uncompensated care will help mitigate the costs associated with a Medicaid expansion. (May 2009)

How Is the Primary Care Safety Net Faring in Massachusetts? Community Health Centers in the Midst of Health Reform reports that community health centers in the state saw an increase in patients from 2005-2007 as the health reform law was implemented. The Massachusetts experience shows that community health centers play a critical role in caring for newly insured patients while continuing to serve as the primary care safety net for those who remain uninsured. (March 2009)

State Fiscal Conditions and Medicaid analyzes the relationship between states’ budgets and their Medicaid programs, and it discusses the current fiscal situation in the states and how it is affecting Medicaid. The report found that declines in tax revenue inhibit states’ ability to meet rising Medicaid costs as enrollment grows, which presents state with tough choices when trying to balance their budgets. (November 2008)

Covering the Uninsured: Growing Need, Strained Resources explains the continued increase in the number of uninsured Americans and examines how federal programs have struggled to stem these increases. (January 2007)

Interactive Children’s Health Insurance Coverage Timeline (2007)

The slide presentation Resuming the Path to Health Coverage for Children and Parents consists primarily of charts showing the state of health insurance access for families. States have shown renewed enthusiasm for covering the uninsured, especially children, but the DRA has also caused some setbacks. (January 9, 2007)

Selected changes to current Medicare policies and practices could help ensure further access to health care and contribute financial security for the nearly 200,000 Medicare beneficiaries displaced by Hurricane Katrina. Displaced by Hurricane Katrina: Issues and Options for Medicare Beneficiaries identifies issues and challenges for individuals on Medicare who were affected by Hurricane Katrina and offers options to address the problems they have encountered. The brief also identifies areas to be considered in future disaster planning efforts. (November 2005)

Policymakers at both the state and federal level have expressed interest in the concept of premium assistance, which entails the use of federal and state funds to subsidize the purchase of employer-sponsored or other private coverage for Medicaid and SCHIP (State Children's Health Insurance Program) beneficiaries. Serving Low-Income Families through Premium Assistance: A Look at Recent State Activity examines new Bush Administration policies associated with using Medicaid and/or SCHIP funds to promote private insurance options, ways that states have responded to these new policies, and key questions that policymakers and others should consider as they think about premium assistance programs. (October 2003)

Covering the Uninsured: How Much Would It Cost? presents the results of a study that was designed to provide benchmarks for evaluating the costs of alternative proposals to cover the uninsured. It provides two sets of cost estimates derived from medical spending patterns of lower- or middle-income people with private coverage and people with public coverage during the 1996-1998 period. The authors estimate that the cost of medical care provided to the newly insured would run between $34 and $69 billion per year if they were fully insured, depending on the approach taken. (June 2003)

From The Kaiser Family Foundation:

Focus on Health Reform: Issues for Structuring Interim High-Risk Pools discusses the creation of high-risk pools in federal health reform legislation for people who are denied private coverage based on their health status. The brief examines the current role of high-risk pools as a safety net for coverage and reviews key issues involved in implementing a national high-risk pool. (January 2010)

Is the Health Care System Ready for Health Reform? is a webcast that examines how the system will handle newly eligible individuals after the enactment of health reform. It also discusses how health reform will affect people living in underserved areas, specifically people of color, and the issues they continue to face in terms of getting access to needed care. (November 2009)

In Pursuit of Affordable Health Care: On the Ground Lessons from Families in Massachusetts details how the state’s health reform legislation has achieved near-universal coverage (94.7 percent) by combining a foundation of public coverage with greater access to private insurance through employers. While some budgetary challenges remain, the program has been largely successful, including a marked increase in job-based coverage. (September 2009)

Explaining Health Reform: What Are Health Insurance Subsidies? explains what insurance subsidies are and how they can help lower-income families and individuals afford health coverage. The brief also examines different ways of structuring subsidies and describes how each would affect the reform proposals that are currently under discussion in Congress. (August 2009)

State Variation and Health Reform discusses how the impact of reform on individual states will vary based on their economic situation, current health coverage, and health care expenditures. This analysis pulls together key information related to state variation, including their economic profiles, Medicaid and CHIP eligibility and enrollment levels, coverage of the non-elderly population, and their individual and small-group markets. (July 2009)

Health Insurance Coverage for Older Adults: Implications of a Medicare Buy-In examines the barriers to securing affordable coverage in the current marketplace for uninsured people ages 55-65, as well as how a Medicare buy-in program could improve health coverage for this group. (May 2009)

Health Coverage for Children and Families in Medicaid and SCHIP: State Efforts Face New Hurdles reports that, between July 2006 and January 2008, nearly two-thirds of states expanded access in these public programs. The report contains state-specific charts and tables that show changes in health coverage, income thresholds for parents applying for Medicaid, and the way that the August 2007 CMS directive affected states. (January 2008)

Massachusetts Health Reform Tracking Survey finds that prior to the July 1 implementation of comprehensive health reform, most Massachusetts residents supported a new state law to provide health coverage to almost all residents, including the individual mandate that requires residents to obtain coverage or pay a penalty. (June 2007)

Employer-sponsored health insurance is especially important for immigrant families because their eligibility for public coverage, including SCHIP and Medicaid, is restricted. The Role of Employer-Sponsored Health Coverage for Immigrants: A Primer examines the importance of employer-based coverage and the specific hurdles immigrants face in obtaining health insurance. The primer is available in both English and Spanish. (June 2006)

Massachusetts has enacted a health care plan designed to offer virtually universal health coverage. Massachusetts Health Care Reform Plan summarizes the new plan and its implications for individuals, who must obtain insurance or face tax penalties, as well as employers, who must provide insurance or contribute to the government’s “Fair Share” program. (April 2006)

Beneath the Surface: Barriers Threaten to Slow Progress on Expanding Health Coverage of Children and Families is an annual 50-state survey of enrollment and eligibility policies in Medicaid and SCHIP. It reveals that nearly half of the states (23) took actions that made it more difficult to secure and retain health coverage for children and families. The actions include: freezing enrollment; more stringent enrollment and retention procedures; and increasing premiums or expanding application of premiums to lower-income families. (October 2004) 

A First Glance at the Children's Health Initiative in Santa Clara County, California This new background report from the Kaiser Family Foundation examines the efforts of Santa Clara County to provide health insurance coverage to all children living in the county. It is one of the first localities to attempt such an initiative. Among the "lessons learned" from the implementation process so far is that "with sufficient political will and significant financial resources, counties and cities do not have to wait for changes in federal and state policy to expand health insurance coverage to children." (August 2001)

From The Kaiser Family Foundation, National Public Radio, and the Harvard School of Public Health:

The Public on Requiring Individuals to Have Health Insurance presents survey results from 1,704 adults concerning their views about different approaches for expanding health coverage, including mandates. The survey questions dealt predominantly with the stances of the current presidential candidates. (February 2008)

From Mathematica:

Costs and Benefits of Eliminating the Medicare Waiting Period for SSDI Beneficiaries concludes that even though the costs of eliminating the waiting period would be substantial, there would also be substantial benefits, including fewer beneficiaries delaying needed health care, reduced financial hardships for those who must pay high out-of-pocket costs, and reduced state Medicaid expenditures. (March 2009)

State Policies to Encourage High-Deductible and Limited-Benefit Health Plans: Costs, Constituents, and Concerns looks at state efforts to encourage the use of such plans as a way to provide coverage and describes the costs and enrollment rates of different types of plans. Some states that heavily subsidize premiums for limited-benefit plans have succeeded in enrolling people who were previously uninsured. However, where subsidies have been absent or only modest, there is little evidence that limited-benefit plans enrolled significant numbers of uninsured people. (March 2009)

From The National Conference of State Legislatures:

Prescription Drug Discount, Rebate, Price Control and Bulk Purchasing Legislation discusses the efforts of several states, to help seniors and people with disabilities cope with the rising costs of prescription drugs. (May, 2000)

From The National Health Law Program:

State Initiatives to Improve Access to Dental Care This new report lists a number of actions states have taken to improve access to dental care, particularly for individuals insured through Medicaid. It includes both actions taken and actions considered but not adopted. The activities are listed under four broad headings: reports, legislation, initiatives/projects, and Title V agency. Resource lists are also included after each state.

From the National Institute for Health Care Management Foundation:

The Role of Individual Mandates in Health Care Reform examines the 2006 Massachusetts mandate that all adults purchase health insurance. Several national health care reform proposals include an individual mandate, and a number of other states have considered moving in this direction. The article considers the evidence supporting arguments for and against individual mandates, discusses their nuances in practice, and reviews the available evidence on their effectiveness. (January 2009)

From the National Small Business Association:

Association Health Plan legislation will raise insurance rates argues that health insurance costs for small businesses will rise and the number of uninsured will increase by over one million, if federal Association Health Plan (AHP) legislation is enacted. Find out how and why in this press release. (April 2004)

From The Northwest Federation of Community Organizations:

Access Denied reveals why so many eligible families are being turned away from support programs and what can be done to address the problem (May, 2000)

From The Opportunity Agenda, Families USA, and The Commonwealth Fund:

Identifying and Evaluating Equity Provisions in State Health Care Reform explores how states can increase health equity by expanding health coverage and addressing issues of access to care, quality of care, social determinants of health, and infrastructure reforms. The report also evaluates existing health equity laws, regulations, and reform proposals in five states. (April 2008)

From the Robert Wood Johnson Foundation:

Achieving Universal Coverage through Comprehensive Health Reform: The Vermont Experience looks at three key dimensions of Vermont’s 2006 universal health care legislation: health coverage and affordability, access to health services, and sustainability. Early indications are that the reforms have been successful. Vermont continues to strengthen its system by improving health care quality and containing costs. (October 2009)

Assuring Health Coverage for Rural People through Health Reform compares health insurance trends of rural and urban residents. Rural workers tend to have less job-based coverage and pay more than urban workers for similar plans. Several provisions in the current health reform proposals, such as providing subsidies to purchase insurance and expanding Medicaid, would significantly benefit rural consumers. (October 2009)

Wisconsin’s BadgerCare Plus Coverage Expansion and Simplification: Early Data on Program Impact presents preliminary findings from an evaluation of BadgerCare Plus since its creation in February 2008. The program combines CHIP, Medicaid, and Healthy Start program dollars to create one larger, more streamlined program with expanded eligibility guidelines. Initial data look promising, and as the program develops, it will become clearer whether this type of reform is effective. (October 2009)

Health Reform in Massachusetts: An Update on Insurance Coverage and Support for Reform as of Fall 2008 provides an update of the impact on working-age adults, the primary target of reform policies, as well as an update on public support for health reform. The state has achieved its goal of near universal health coverage, and residents continue to show strong support for health reform, despite the rising costs of the program. (September 2009)

Coverage for Low-Income People: Should the Medicaid Program Be Expanded to Cover More of the Uninsured? Should There Be Changes in the Children’s Health Insurance Program? examines the options being debated by key congressional committees and summarizes arguments for and against expansion of these public programs. The proposed changes could raise income eligibility levels, allow low-income individuals to buy private insurance with help from subsidies, or even enroll in a public option. (July 2009)

Considering a Health Insurance Exchange: Lessons from the Rhode Island Experience highlights the importance of clearly defining the goals of an exchange, and getting major stakeholders to participate, during the health reform process. Rhode Island’s public reform process gave participants a greater understanding of which policy goals could be achieved by the various components of the exchange. States looking to Rhode Island as an example should note the basic steps to be followed when analyzing any exchange model. (June 2009)

From the Robert Wood Johnson Foundation and the State Health Access Data Assistance Center

The Secrets of Massachusetts’s Success: Why 97 Percent of State Residents Have Health Coverage uses interviews with policy makers, stakeholders, advocates, and others to examine how individual elements have contributed to the success of Massachusetts’s health reform legislation. Simplifying and integrating eligibility procedures across multiple programs has played a central role in reducing the number of low-income uninsured. (November 2009)

From the Robert Wood Johnson Foundation and the Urban Institute

Progress Enrolling Children in Medicaid/CHIP: Who Is Left and What Are the Prospects for Covering More Children? notes that improving enrollment and retention processes and tailoring outreach strategies to uninsured children and their communities are crucial. The Medicaid expansion under health reform will also help increase enrollment, but continuing existing efforts will be key to preventing gaps in coverage. (November 2009)

From State Coverage Initiatives:

Health Insurance Connectors & Exchanges: A Primer for State Officials examines a crucial component of the 2006 Massachusetts health care reform law known as “the Commonwealth Health Insurance Connector Authority,” or simply, “The Connector.” The Connector is presented as a prototype that other states can adapt when seeking to expand health coverage, depending on the specific characteristics in those states. (September 2007)

The State Coverage Matrix is an Internet product that provides information on strategies employed by all 50 states and the District of Columbia. It lists coverage expansions made through three categories: Medicaid, the State Children's Health Insurance Program, and state-only programs (programs without federal funding).

From State Coverage Initiatives and Academy Health:

State of the States: Building Hope and Raising Expectations reports that state leaders are increasingly willing to address the rising number of uninsured Americans and are investing in efforts to expand coverage. It outlines the specific developments in a few key states, and it identifies trends that many new state plans have in common. (January 2007)

From the State of Maine:

News from Maine: Universal Coverage Proposed. Gov. John Baldacci has unveiled a plan to cover all uninsured Mainers within four years. The governor's proposal would expand MaineCare (Medicaid) to cover more people and would build a new Dirigo Health Insurance plan to offer coverage for workers in small businesses, the self-employed, and those who don't have access to employer coverage. For a summary of the proposal, click here.

From The U.S. Department of Health and Human Services:

HHS Proposes Changes Allowing States to Expand Medicaid Coverage: The U.S. Department of Health and Human Services recently announced that it will propose new rules to help enable more low-income Americans get Medicaid coverage. The new rules would give states greater flexibility in determining Medicaid eligibility, a change that could potentially benefit tens of thousands of Americans. In particular, it could help the elderly, people with disabilities and families with disabled children to obtain Medicaid coverage while living at home, instead of having to live in nursing care facilities.

From The United States Senate:

Wellstone Introduces The Healthy Americans Act A Bill for Universal Health Care Coverage in America Senator Paul Wellstone (D-MN) introduces a bill that ensures coverage for those who are uninsured, requires that insurance will be affordable and comprehensive, and guarantees quality coverage. (May, 1998)

From The Urban Institute:

Changes to the Tax Exclusion of Employer-Sponsored Health Insurance Premiums: A Potential Source of Financing for Health Reform focuses on a two-part design for reducing or eliminating this tax exclusion: 1) a cap or dollar limit on the amount of job-based health insurance premiums that are excluded from taxable income, and 2) an index that determines how this cap might grow over time. The analysis shows that limiting the tax exclusion would provide substantial funding for health reform and mitigate the inequalities in the current treatment of employer premiums. (June 2009)

Health Savings Accounts and High-Deductible Health Insurance Plans: Implications for Those with High Medical Costs, Low Incomes, and the Uninsured examines the potential for HSAs and HDHPs to reduce health care spending and decrease the number of uninsured. The study finds that the tax structure and incentives built into HSAs make them most attractive to high-income and healthy people who are already advantaged by the current system and that they tend to shift more of the health financing burden onto those needing significant amounts of care. As such, it is not clear that cost containment or reductions in the uninsured will follow. (February 2009)

Massachusetts Health Reform: Solving the Long-Run Cost Problem summarizes the state’s accomplishments, examines its challenges, and suggests four options for addressing long-term costs. It finds that though recent reform measures decreased the number of uninsured by 50 percent and improved access to care, Massachusetts’ per capita health care spending is higher than the national average, and the reforms have incurred higher-than-anticipated costs. (January 2009)

Prospects for Reducing Uninsured Rates among Children: How Much Can Premium Assistance Programs Help? considers the extent to which uninsured children could be covered through premium assistance programs, which use Medicaid or CHIP funding to subsidize employer-based coverage. New data indicate that only 4.6 percent of all Medicaid-eligible uninsured children and 15.9 percent of CHIP-eligible uninsured children have a parent with employer-based coverage. This suggests that premium assistance programs may not make a substantial dent in the numbers of uninsured children. (January 2009)

Health Insurance for Low-Income Working Families proposes comprehensive reforms that are designed to provide coverage for everyone at every income level, while still encouraging work. According to the study, in 2005, only 37 percent of adults in low-income working families had employer-based health insurance, and 42 percent had no health coverage. The proposals include state purchasing pools, individual mandates, and strategies for reducing health care costs. (July 2008)

Health Insurance Coverage of Young Adults: Issues and Broader Considerations looks at why young adults are disproportionately uninsured and what policies could address this coverage gap. Nearly one in three adults ages 19-26 lack health insurance. (June 2008)

Do Individual Mandates Matter? concludes that universal health coverage is not possible without an individual mandate and that large numbers of people would be left uninsured without one. Without universal coverage, the government would have difficulty redirecting current spending on the uninsured to offset some of the costs associated with a new program. (January 2008)

Increasing Health Insurance Coverage of Workers in Small Firms: Challenges and Strategies: Testimony before the Finance Committee United States Senate calls for a reduction of small business owners that are uninsured. It suggests income-related subsidization of insurance coverage. (October 2007)

Between 2001 and 2005, Americans have seen a significant decline in employer-sponsored health coverage. Medicaid and the State Children’s Health Insurance Program (SCHIP) were created to provide assistance for low-income families who are especially vulnerable because they cannot afford to purchase private health coverage. The Role of Medicaid and SCHIP as an Insurance Safety Net examines data from across the states to assess the two programs’ effectiveness in offsetting declining employer-sponsored coverage for low-income children and adults. (August 2006)

Roadmap to Coverage: Synthesis of Findings combines all of the research and analytic work done on the Massachusetts health coverage initiative, describes three policy approaches that would achieve universal coverage in the Commonwealth, and discusses the issues that would need to be addressed in order to implement the Roadmap options. (May 2006)

Mounting empirical evidence, policy research, and reports in the popular press attest to the fact that the U.S. health care system is inadequate when it comes to ensuring access to care for those with the greatest health care needs. Lowering Financial Burdens and Increasing Health Insurance Coverage for Those with High Medical Costs shows that many adults and families are contending with considerable financial burdens when it comes to paying for health care, even when they have health insurance. (December 2005)

Does the Health Care Safety Net Narrow the Access Gap? presents the results of a study that examined the role of the health care safety net in increasing health care use and access for uninsured adults and in narrowing the gap between the uninsured and the insured. The study found little variation in use of and access to health services among low-income adults when examining local safety net conditions, but it found large differences according to insurance status. The authors therefore argue that expanding health coverage would be a more effective tool for increasing health care use and access among low-income adults than expanding the safety net. (April 2003)

Health Care Access for Uninsured Adults: A Strong Safety Net Is Not the Same as Insurance examines the extent to which differences in the safety-net environment account for differences in access to and use of health care by the uninsured. The brief draws on representative samples of the population from 13 states (AL, CA, CO, FL, MA, MI, MN, MS, NJ, NY, TX, WA, WI) and focuses on low-income adults and on residents of metropolitan areas. (January 2002)

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