The Uninsured: Increasing Coverage
Many states are trying to expand coverage. Click here for info on state campaigns.
From Families USA:
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:
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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 Center for Studying Health System Change:
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:
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 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:
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 Community Catalyst:
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 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 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:
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:
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:
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 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 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 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:
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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