Expand Health Insurance Coverage Research Articles

Prospects for expanding health insurance coverage.

It should be a no-brainer. Every citizen of the most prosperous nation in the world should have basic health insurance. Yet lack of health insurance remains one of the most glaring examples of how the United States differs from other countries.1,2 Despite a robust economy, the number of uninsured nonelderly persons increased steadily in the 1990s, reaching 43.9 million in 1998 before dropping slightly in 1999, to 42.1 million (Figure 1).3 This welcome decline in the number of uninsured persons, however, offers no guarantee that the overall trend has changed. Health care costs and insurance premiums are once again . . .

The effects of chronic medical conditions on work loss and work cutback.

Although work performance has become an important outcome in cost-of-illness studies, little is known about the comparative effects of different commonly occurring chronic conditions on work impairment in general population samples. Such data are presented here from a large-scale nationally representative general population survey. The data are from the MacArthur Foundation Midlife Development in the United States (MIDUS) survey, a nationally representative telephone-mail survey of 3032 respondents in the age range of 25 to 74 years. The 2074 survey respondents in the age range of 25 to 54 years are the focus of the current report. The data collection included a chronic-conditions checklist and questions about how many days out of the past 30 each respondent was either totally unable to work or perform normal activities because of health problems (work-loss days) or had to cut back on these activities because of health problems (work-cutback days). Regression analysis was used to estimate the effects of conditions on work impairments, controlling for sociodemographics. At least one illness-related work-loss or work-cutback day in the past 30 days was reported by 22.4% of respondents, with a monthly average of 6.7 such days among those with any work impairment. This is equivalent to an annualized national estimate of over 2.5 billion work-impairment days in the age range of the sample. Cancer is associated with by far the highest reported prevalence of any impairment (66.2%) and the highest conditional number of impairment days in the past 30 (16.4 days). Other conditions associated with high odds of any impairment include ulcers, major depression, and panic disorder, whereas other conditions associated with a large conditional number of impairment days include heart disease and high blood pressure. Comorbidities involving combinations of arthritis, ulcers, mental disorders, and substance dependence are associated with higher impairments than expected on the basis of an additive model. The effects of conditions do not differ systematically across subsamples defined on the basis of age, sex, education, or employment status. The enormous magnitude of the work impairment associated with chronic conditions and the economic advantages of interventions for ill workers that reduce work impairments should be factored into employer cost-benefit calculations of expanding health insurance coverage. Given the enormous work impairment associated with cancer and the fact that the vast majority of employed people who are diagnosed with cancer stay in the workforce through at least part of their course of treatment, interventions aimed at reducing the workplace costs of this illness should be a priority.

Avoiding health insurance crowd-out: evidence from the medicare as secondary payer legislation

The cost of expanding health insurance coverage increases when people who would otherwise purchase insurance obtain public coverage. This paper investigates the effects of one of the first efforts to target insurance benefits to the most needy, the 1982 medicare as secondary payer (MSP) provisions. We find strong evidence of low compliance with the MSP both in terms of medical bill payments (payment compliance) and employer-sponsored insurance coverage (coverage compliance). We estimate payer compliance at approximately 33%. Coverage compliance is lower, at under 25%. We find weak evidence that the MSP caused older workers to shift toward MSP-exempt jobs.

Out of the closet and into the legislature: breast cancer stories.

Narrative Matters Health AffairsVol. 20, No. 1: Expanding Health Coverage Out Of The Closet And Into The Legislature: Breast Cancer StoriesBarbara F. SharfPUBLISHED:January/February 2001No Accesshttps://doi.org/10.1377/hlthaff.20.1.213AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSBreast cancerCancerDiseasesClinical trialsBiopsyHIV/AIDSGovernment programs and policiesCancer patientsSurgeryWomen's health Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 19 History Published online 1 January 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byDoes Neighborhood Cohesion Moderate the Association between Cancer and Psychological Distress?2 September 2021 | Journal of Applied Social Science, Vol. 16, No. 1Brave. Bold. Gold: Athletic Activism and the Realities of Childhood Cancer13 August 2019 | Health Communication, Vol. 35, No. 11Using narratives to impact health policy-making: a systematic review5 March 2019 | Health Research Policy and Systems, Vol. 17, No. 1“We Are the Visible Proof”: Legitimizing Abortion Regret Misinformation through Activists’ Experiential Knowledge27 December 2017 | Law & Policy, Vol. 40, No. 1Telling Global Public Health Stories8 July 2016 | Communication Research, Vol. 43, No. 6Unproven stem cell–based interventions and achieving a compromise policy among the multiple stakeholders4 November 2015 | BMC Medical Ethics, Vol. 16, No. 1Communication and Social Change: Research Methods23 July 2015Communication and Social Change: Research Methods1 July 2015Risky and resilient life with dementia: review of and reflections on the literatureHealth, Risk & Society, Vol. 15, No. 5Methodological diversity and integration in health communication inquiryPatient Education and Counseling, Vol. 82, No. 3Qualitative Inquiry and the Future of Health Communication ResearchQualitative Research Reports in Communication, Vol. 9, No. 1Narrative(,) citizenship and dementia: The personal and the politicalJournal of Aging Studies, Vol. 22, No. 3Communication and Social Change: Research Methods5 June 2008Metaphor Shifts in Stroke RecoveryHealth Communication, Vol. 21, No. 3Will Coverage for Child and Adolescent Immunizations Be Mandated for Insurance Plans in 2006? Lessons Learned From the Newborns' and Mothers' Health Protection Act of 19961 July 2006 | Pediatrics, Vol. 118, No. 1Interventions for patients, providers, and health care organizations1 January 2004 | Cancer, Vol. 101, No. S5Pink Ribbons Inc: breast cancer activism and the politics of philanthropyInternational Journal of Qualitative Studies in Education, Vol. 17, No. 4Oncology Social Work for SurvivorshipIncorporating Evidence Into Health Policy Decisions

A founder of quality assessment encounters a troubled system firsthand. Interview by Fitzhugh Mullan.

Interview Health AffairsVol. 20, No. 1: Expanding Health Coverage A Founder of Quality Assessment Encounters A Troubled System FirsthandFitzhugh MullanPUBLISHED:January/February 2001No Accesshttps://doi.org/10.1377/hlthaff.20.1.137AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSNursesQuality of careHealth maintenance organizationsClinicsCancer patientsCancerSurgeryNursingClinical carePublic health Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 38 History Published online 1 January 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byPeers, Professionalism, and Improvement — Reframing the Quality QuestionNew England Journal of Medicine, Vol. 386, No. 19Reassessing Quality Assessment — The Flawed System for Fixing a Flawed SystemNew England Journal of Medicine, Vol. 386, No. 17The Joint Commission Journal on Quality and Patient Safety, Vol. 48, No. 6-7Leading with Love: Five Practical Tips8 April 2021 | Journal of General Internal Medicine, Vol. 36, No. 11Reply to Fakih and Advani2 April 2021 | Clinical Infectious Diseases, Vol. 318Quality and Standards for Haematopoietic Stem Cells Transplantation Programs20 February 2021A Brief History of Quality Improvement in Health Care and Spinal Surgery6 January 2020 | Global Spine Journal, Vol. 10, No. 1_supplA Multilayered Research Framework for Humanities and Epidemiology of Medicinal Product Risk Communication18 June 2020I Care (Coordinate) About YouJournal of Graduate Medical Education, Vol. 11, No. 1The Innovative Potential of 'Medicare-for-All'SSRN Electronic JournalMental health quality improvement goes global19 January 2018 | World Psychiatry, Vol. 17, No. 1Donabedian’s Lasting Framework for Health Care QualityNew England Journal of Medicine, Vol. 375, No. 3Facing disasters15 March 2016 | Catheterization and Cardiovascular Interventions, Vol. 87, No. 4Minding Ps and Qs: The Political and Policy Questions Framing Health Care Spending1 January 2021 | Journal of Law, Medicine & Ethics, Vol. 44, No. 4The Surgical Care Improvement Project Antibiotic GuidelinesAnesthesia & Analgesia, Vol. 121, No. 2Revisiting structure, process, and outcome22 October 2014 | Cancer, Vol. 121, No. 3The Quality Imperative for Palliative CareJournal of Pain and Symptom Management, Vol. 49, No. 2The Power of Embedded Critics19 March 2014 | Journal of General Internal Medicine, Vol. 29, No. 7Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study1 June 2014 | Health Services and Delivery Research, Vol. 2, No. 17Macro vs Micro Level Surgical Quality Improvement: A Regional Collaborative Demonstrates the Case for a National NSQIP InitiativeJournal of the American College of Surgeons, Vol. 218, No. 4Journal of Oncology Practice, Vol. 10, No. 3Seven Propositions of the Science of ImprovementQuality Management in Health Care, Vol. 22, No. 3High-volume trauma centers have better outcomes treating traumatic brain injuryJournal of Trauma and Acute Care Surgery, Vol. 74, No. 1Quality measures in health care: Have they always been with us?12 August 2009 | Journal of Research in Nursing, Vol. 14, No. 4Managing quality in an anesthesia departmentCurrent Opinion in Anaesthesiology, Vol. 22, No. 2Nursing Peer ReviewJONA: The Journal of Nursing Administration, Vol. 38, No. 11Nurses' Perceptions of Glycemic Control in Patients Who Have Undergone Cardiac SurgeryClinical Nurse Specialist, Vol. 22, No. 6Health Care Policy, Quality Improvement, and Patient Safety in Pain Medicine PracticePresident’s Page: Making Imaging MeaningfulJournal of the American College of Cardiology, Vol. 47, No. 7Promoting informed decisions about cancer screening in communities and healthcare systemsAmerican Journal of Preventive Medicine, Vol. 26, No. 1An introduction to quality assurance in health careAmerican Journal of Preventive Medicine, Vol. 26, No. 1Reflections on Quality Health CareNursing Administration Quarterly, Vol. 27, No. 4Organizational Characteristics and Restraint Use for Hospitalized Nursing Home ResidentsJournal of the American Geriatrics Society, Vol. 51, No. 8An Introduction to Quality Assurance in Health CareJAMA: The Journal of the American Medical Association, Vol. 290, No. 1Patient Safety: Maintaining the MomentumJournal For Healthcare Quality, Vol. 24, No. 3Alvan Feinstein:The American Journal of Medicine, Vol. 112, No. 6Foreword: Preventing Medical Accidents: Is “Systems Analysis” The Answer?24 February 2021 | American Journal of Law & Medicine, Vol. 27, No. 2-3Process Change in Health Care Institutions: Top-Down or Bottom-Up?

A Flexible Benefits Tax Credit For Health Insurance And More

This essay outlines a concept for a "flexible benefits" tax credit for expanding health insurance coverage and other purposes such as retirement savings plans (with potential withdrawals for higher education, first-home ownership, and catastrophic medical expenses). Two examples are presented. The advantages of a flexible benefits tax credit are considered in terms of efficient use of the budget surplus to help meet the varied (and changing) needs of American families, to eliminate major national gaps in health insurance and pension coverage, and to advance other objectives. If the budget surplus is used wisely, political decisionmakers could achieve health insurance coverage for most uninsured workers and children and assure a future with real economic security for American families.

Increments Toward What?

Incremental proposals to expand health insurance coverage, such as expansions of the State Children's Health Insurance Program (SCHIP) or creation of new tax credits, should be examined for the values that underlie them and for how they structure future options for additional incremental coverage expansions. This paper examines five design issues in incremental reform: who determines coverage options for the newly insured; what risk pool do they enter; what is the government's contribution toward their coverage; what barriers are created by efforts to encourage efficiency; and how are issues of federalism handled? Tax credits are a departure from past approaches, while an SCHIP expansion is a continuation of current policy directions.

Why do compensating differentials matter?

Following the demise of President Clinton's health care reform initiative in 1994, policy makers have adopted a series of incremental strategies to expand health insurance coverage. To date, those strategies have focused primarily on expansions of public coverage, through the State Children's Health Insurance Program (SCHIP), enacted by the Congress in 1997, and a variety of state initiatives to expand Medicaid and other coverage programs. In the latter half of the 1990s, the Congress also enacted legislation to facilitate the portability of private health insurance and to phase in the deductibility of premiums for the selfemployed-initiatives that were unlikely to have much impact on coverage overall. Recently, federal policymakers have become increasingly interested in expanding tax subsidies to boost private health insurance coverage among low-to-moderate-income individuals and families, as well as in the possibility of broadening eligibility for SCHIP to include adults. Proposals for tax subsidies, which typically take the form of refundable tax credits, vary according to the target population (consumers, employers, or both); the criteria for eligibility; whether consumers could use subsidies only to purchase coverage in the individual market or whether workers' out-of-pocket premiums for employer-sponsored insurance (ESI) would also be eligible for subsidies; and the maximum subsidy amounts. Thus, for example, President Bush's proposal, released earlier this year, would provide tax credits for purchasing insurance in the individual market by those who are ineligible for either ESI or public coverage. Full subsidies would be available for individuals with annual income up to $15,000 and families with annual income up to $30,000, and would phase out above those levels. The maximum subsidy amounts would be $1,000 for individuals and $2,000 for families.1 By contrast, a bipartisan bill in the Senate (S. 590) would provide

Medicaid coverage for tobacco-dependence treatments.

Update Health AffairsVol. 20, No. 1: Expanding Health Coverage STATE REPORTMedicaid Coverage For Tobacco-Dependence TreatmentsHelen Halpin Schauffler, Dianne C. Barker, and C. Tracy OrleansPUBLISHED:January/February 2001No Accesshttps://doi.org/10.1377/hlthaff.20.1.298AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSMedicaidState MedicaidSmokingSmoking cessationDiseasesGovernment programs and policiesCost-effectivenessMedicaid coverageFederal health plansDrug therapy Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 24 History Published online 1 January 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF downloadCited byThe Tobacco Control Experience: A Model for Substance Use Prevention?2 March 2019Affordable Care Act Impact on Medicaid Coverage of Smoking-Cessation TreatmentsAmerican Journal of Preventive Medicine, Vol. 54, No. 4Variation in Coverage for Progesterone to Prevent Preterm Birth: A Survey of Medicaid Managed Care OrganizationsWomen's Health Issues, Vol. 27, No. 5Impact of Increasing Coverage for Select Smoking Cessation Therapies With no Out-of-Pocket Cost Among the Medicaid Population in Alabama, Georgia, and MaineJournal of Public Health Management and Practice, Vol. 22, No. 1Impact of Broadened Coverage of Smoking Cessation Treatments on Cardiovascular Disease3 October 2012 | Current Cardiovascular Risk Reports, Vol. 6, No. 6Cancer-Related News from the CDC: State Medicaid Coverage for Tobacco-Dependence TreatmentsOncology Times, Vol. 31, No. 23Treatment of Smokers with Co-Occurring Disorders: Emphasis on Integration in Mental Health and Addiction Treatment SettingsAnnual Review of Clinical Psychology, Vol. 5, No. 1Identifying health disparities across the tobacco continuumAddiction, Vol. 102State Medicaid Coverage for Tobacco-Dependence TreatmentsOncology Times, Vol. 29, No. 12Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine OrganizationsAnnals of Emergency Medicine, Vol. 48, No. 4Tobacco Control Interventions in the Emergency Department: A Joint Statement of Emergency Medicine OrganizationsJournal of Emergency Nursing, Vol. 32, No. 5Prevalence and Trends in Smoking: A National Rural StudyThe Journal of Rural Health, Vol. 22, No. 2Medicaid Coverage For Tobacco-Dependence TreatmentsHealth Affairs, Vol. 25, No. 2Disparity in the Use of Smoking Cessation Pharmacotherapy Among Medicaid and General Population SmokersJournal of Public Health Management and Practice, Vol. 11, No. 4Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trialAddiction, Vol. 100, No. 7A randomized trial to promote pharmacotherapy use and smoking cessation in a Medicaid population (United States)Cancer Causes & Control, Vol. 16, No. 4IMPACT OF NICOTINE REPLACEMENT THERAPY ON SMOKING BEHAVIORAnnual Review of Public Health, Vol. 26, No. 1Effectiveness of a quit and win contest with a low-income populationPreventive Medicine, Vol. 39, No. 3Physician and enrollee knowledge of Medicaid coverage for tobacco dependence treatmentsAmerican Journal of Preventive Medicine, Vol. 26, No. 2Implementation of Evidence-Based Tobacco Use Cessation Guidelines in Managed Care OrganizationsAnnals of Behavioral Medicine, Vol. 27, No. 1Reversal of Misfortune: Viewing Tobacco as a Social Justice IssueAmerican Journal of Public Health, Vol. 94, No. 2Geographic pattern of cancers related to tobacco and alcohol in Connecticut: implications for cancer controlCancer Detection and Prevention, Vol. 28, No. 4Support for Smoking Cessation Interventions in Physician OrganizationsMedical Care, Vol. 41, No. 12Current strategies for cessation of smoking for head and neck cancer patientsCurrent Opinion in Otolaryngology & Head and Neck Surgery, Vol. 10, No. 2

Otherworldly Delivery Systems

Otherworldly Delivery Systems

Building a consensus for expanding health coverage.

Despite a flourishing economy and recent growth in employment-based health coverage, forty-three million Americans remain uninsured. Extending coverage to the uninsured is not an intractable public policy problem but could be addressed if the various health care stakeholders could only find common ground. We argue that to win broad-based support from across the ideological and political spectra, a meaningful proposal should achieve a balance between public- and private-sector approaches, focus attention on those who are most in need of assistance (low-income workers), and build on systems that work today. With the aim of pulling together a political coalition, we present a proposal specific enough to attract support but whose details will arise later, in the context of the legislative process.

Health care in the upcoming 2000 election.

Health care will be one of the top issues in the year 2000 election, but voters' interest in health care is not as great as it was in 1992. There is no single unifying theme to the health care issue. Rather, there are multiple concerns: making Medicare financially sound, providing coverage for prescription medicines for seniors, covering the uninsured, and addressing patients' rights. Voters favor an incremental approach to expanding health insurance coverage rather than a major program. They express about equal levels of support for plans similar in concept to those proposed by presidential candidates Al Gore and George W. Bush.

Reproductive health services for adolescents: Critical legal issues

The contemporary legal and policy environment has increased the challenges associated with providing health care services to the adolescent population. The issue of reproductive health care services is particularly intense because of the controversial nature of services for contraception and abortion. As the debates continue, one must remember the background against which they are occurring. The current legal framework, developed over nearly 40 years, enables adolescents who are minors to give their own consent for care in numerous circumstances and provides them with a significant level of confidentiality protection, particularly for reproductive health services. Laws have been enacted to expand adolescents' financial access to health care, through targeted publicly funded service programs and expanded health insurance coverage. This background provides the foundation for addressing the current challenges and for protecting and expanding adolescents' access to care.

Evaluating Child Health Plus in Upstate New York: How Much Does Providing Health Insurance to Uninsured Children Increase Health Care Costs?

In response to the increase in the number of American children without health insurance, new federal and state programs have been established to expand health insurance coverage for children. However, the presence of insurance reduces the price of care for families participating in these programs and stimulates the use of medical services, which leads to an increase in health care costs. In this article, we identified the additional expenditures associated with the provision of health insurance to previously uninsured children. We estimated the expenditures on additional services using data from a study of children living in the Rochester, New York, area who were enrolled in the New York State Child Health Plus (CHPlus) program. CHPlus was designed specifically for low-income children without health insurance who were not eligible for Medicaid. The study sample consisted of 1910 children under the age of 6 who were initially enrolled in CHPlus between November 1, 1991 and August 1, 1993 and who had been enrolled for at least 9 continuous months. We used medical chart reviews to determine the level of primary care utilization, parent interviews for demographic information, as well as specialty care utilization, and we used claims data submitted to CHPlus for the year after enrollment to calculate health care expenditures. Using this information, we estimated a multivariate regression model to compute the average change in expenditures associated with a unit of utilization for a cross-section of service types while controlling for other factors that independently influenced total outpatient expenditures. Expenditures for outpatient services were closely related to primary care utilization-more utilization tended to increase expenditures. Age and the presence of a chronic condition both affected expenditures. Children with chronic conditions and infants tended to have more visits, but these visits were, on average, less expensive. Applying the average change in expenditures to the change in utilization that resulted from the presence of insurance, we estimated that the total increase in expenditures associated with CHPlus was $71.85 per child in the year after enrollment, or a 23% increase in expenditures. The cost increase was almost entirely associated with the provision of primary care. Almost three-quarters of the increase in outpatient expenditures was associated with increased acute and well-child care visits. CHPlus was associated with a modest increase in expenditures, mostly from additional outpatient utilization. Because the additional primary care provided to young children often has substantial long-term benefits, the relatively modest expenditure increases associated with the provision of insurance may be viewed as an investment in the future.

Three political realities in expanding coverage for the working poor: one state's experience.

In recent years, states have experimented with innovative approaches to expand coverage for underserved persons. Yet lack of health insurance among low income workers remains a problem. A 1997 survey reported that more than half of adults in low income, working families have been uninsured sometime in the previous two years. This group is likely to increase in the future as states implement time-limited welfare benefits and if employer-sponsored health coverage continues to decrease as in recent years. This paper describes the bipartisan effort of the Indiana Commission on Health Care for the Working Poor to design coverage expansions for uninsured, low income workers and families in Indiana. Initially, legislators challenged the state's insurance industry to develop a private health insurance plan that the state might subsidize to make it affordable to low income workers and/or their employers. However, based on findings from Indiana focus groups of working poor that the Commission conducted, the Commission recommended strategies to mobilize existing safety net providers into networks to provide comprehensive and coordinated care to low income workers and families in designated service areas. Specifically, the state would pay direct subsidies for primary and preventive care to community health centers that participate in networks with safety net hospitals. Also, the state would establish a state-sponsored stop loss fund to protect network hospitals against expenses incurred in the care of catastrophically ill network clients. These strategies reflect three realities that face states as they craft health coverage expansions for uninsured low income workers and families in today's health policy environment. First, in a conservative state, policy makers are unwilling to pay the cost of even limited coverage for low income workers and families. Second, the uninsured poor already obtain care from safety net providers that are programmatically constituted and ideologically committed to serve them. Third, this lack of demand for health coverage with minimum benefits threatens voluntary participation in a subsidized private program. The findings of the focus groups confirmed that, unless heavily subsidized, it is unlikely that low income workers are going to purchase even heavily subsidized health insurance to finance their health care. Given the constraints of the day, addressing the need for health coverage for the remaining uninsured calls for innovative thinking beyond conventional paradigms. Direct subsidies for community health centers and subsidized stop loss protection for safety net hospitals to facilitate the development of networks are promising strategies for extending coverage to uninsured, low income workers and families. While not a substitute for enrollment in a fully-paid health plan, these strategies do promise real improvement in access to high quality health care services for this group of vulnerable Americans.

Welfare and immigration reforms: unintended side effects for Medicaid.

Welfare reform and changes in immigrants' eligibility may lead to significant reductions in Medicaid caseloads, even though many states are expanding Medicaid eligibility rules to accommodate changes under the new welfare programs. In 1996, for the first time in almost a decade, Medicaid participation of adults and children fell about 2 percent, and further reductions seem likely in 1997. The gradual restrictions on new immigrants also will affect future caseloads. Although new initiatives such as the State Children's Health Insurance Program (CHIP) should expand health coverage for children, the welfare reform and immigration changes will disproportionately lead to loss of insurance among adults.

The State Children's Health Insurance Program (CHIP)

Between 7 million and 10 million children in the United States lack health insurance. Many of these uninsured children experience difficulty obtaining needed health care.1 To expand health insurance coverage for children, in August 1997, Congress enacted the State Children’s Health Insurance Program (CHIP) as part of the Balanced Budget Act of 1997.2 CHIP, also known as Title XXI of the Social Security Act, offers states new federal funding in the form of block grants to provide “child health assistance to uninsured children in low-income families in an effective and efficient manner that is coordinated with other sources of health benefits coverage for children.” The program is authorized for 10 years and is expected to provide insurance coverage for millions of currently uninsured children. Federal expenditures on child health assistance under the law are estimated to total $40 billion to $50 billion over the life of the legislation.

The states and health care reform: the road traveled and lessons learned from seven that took the lead.

During the past decade, an area of major policy activity among the states has been that of health care reform. As of May 1993, seven states--Florida, Hawaii, Massachusetts, Minnesota, Oregon, Vermont, and Washington--had progressed the furthest in enacting comprehensive statutes designed to expand health insurance coverage and slow the growth of health care costs. This article reviews the activities of these states to achieve health care reform and the lessons learned from those activities. The analysis focuses specifically on identifying the common problems addressed and determining the common factors that maximized states' opportunities for success. In all, some nine lessons are identified that have relevance for other states wishing to follow a similar road to reform. Most important among these are a "window of opportunity" for policy action, having entrepreneurial leadership to push the reform agenda forward, and support from key stakeholder interests. If these conditions of opportunity, policy entrepreneurship, and stakeholder commitment are met, a state can move forward in addressing key aspects of its health care reform agenda.

Expanding health insurance coverage for uninsured children: the next step in health care reform?

Series Editor's Note: This article provides a comprehensive look at many of the health policy issues related to children 3health insurance. It was originally written in April 1997 when the outcome of foderallegislation was unclear. Even though Congress has recently decided to increase health insurance coverage for children, however, the issues presented in this paper remain critically important. Because this new legislation is expected to provide coverage for fewer than one quarter of the currently uninsured children, it is likely that Congress will revisit these same issues again in the near future. In

Pursuing Broader Access

From The Publisher Health AffairsVol. 16, No. 1 Pursuing Broader AccessWilliam B. Walsh AffiliationsPublisher & Founder, Project HOPEPUBLISHED:January/February 1997Free Accesshttps://doi.org/10.1377/hlthaff.16.1.6AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSUninsuredAccess to careInsurance coverage and benefitsClinical careThe recent election produced no change in the political alignment of Congress and the executive branch, but it did underscore the remarkable absence of societal concern about the number of persons who lack ready access to medical care. But this seeming lack of concern should not deter policymakers from continuing to search for ways to provide insurance coverage to all of our citizens, one way or another. Current estimates place the nation's uninsured population at some forty million persons, while another twenty-nine million persons are deemed to be underinsured. An informative new national telephone survey of 3,993 adults, the results of which were published in the Journal of the American Medical Association (23-30 October 1996), identified the problems that uninsured and insured people have in getting and paying for medical care in today's changing system. The uninsured were four times more likely than the insured to report an episode of needing and not getting medical care, and three times more likely to report a problem in paying their medical bills. Cost and the lack of employer-provided coverage were the principal reasons cited for being uninsured. As Congress reconvenes and develops its health policy priorities, it should certainly not neglect the vexing issues surrounding persons who lack insurance. While the comprehensive approach to health care reform put forward by the Clinton administration was repudiated, it was heartening to hear the president say in his first postelection news conference that he would seek to expand insurance coverage on an incremental basis. One option he suggested, as have congressional Democrats, is to expand health insurance coverage for children, particularly those whose parents are not poor enough to qualify for Medicaid but lack the means to afford private health insurance. Policymakers might consider as a starting point the ideas contained in a paper by Linda Blumberg and Len Nichols, published in Health Affairs, Fall 1996. In that paper the authors provided four proposals for improving the health insurance market. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 January 1997 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.PDF download