The Uninsured: Increasing Coverage

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From Families USA and Small Business Majority:

Good Business Sense: The Small Business Health Care Tax Credit in the Affordable Care Act provides national and state-level estimates of the number of small businesses that will be eligible for this tax credit and of how much the credits will be worth. It also includes data on how many workers could benefit as a result, broken down according to racial and ethnic group. (May 2012)

From Families USA:

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. (Updated February 2012)

The Bottom Line: How the Affordable Care Act Helps America's Families shows the net financial effects of the Affordable Care Act on family budgets. We found that lower- and middle-income families, both uninsured and insured, will be financial winners. | State Reports (October 2011)

Presumptive Eligibility: A Step toward Streamlined Enrollment in Medicaid and CHIP explores how the Affordable Care Act expands presumptive eligibility to help states streamline enrollment and discusses the important role that presumptive eligibility can play in helping low-income people get access to care during and after the implementation of the new law. (September 2011)

Why We Need a Health Insurance Exchange is a one-page handout that cites several reasons why consumers will benefit from the new exchanges, including competition, affordability, and quality. Advocates can modify this version to fit their needs. (June 2011)

House Republicans Propose to Slash Funding for Medicaid, Medicare, and Other Health Coverage Programs takes a closer look at how the recent budget proposal would harm seniors, children, and state economies, including state-specific numbers. (April 2011)

Lower Taxes, Lower Premiums: The New Health Insurance Tax Credit examines how this tax credit will help both insured and uninsured Americans. It provides data on the number of people eligible, the total dollars available, and on how it will help working families in particular. | State Reports (September 2010)

The First 90 Days: A State Advocate's To-Do List provides an overview of the provisions to be implemented in the first 90 days, including coverage for uninsured people with pre-existing conditions, grants for consumer assistance offices, and Medicaid and CHIP maintenance of effort requirements. | pdf version (April 2010)

A Summary of the New Health Reform Law describes the major changes in health coverage that health reform will bring, including Medicaid and CHIP coverage, the affordability provisions, the exchanges, individual and employer responsibility requirements, improvements in private market coverage, and changes to Medicare and long-term services. (April 2010)

What Will the New Health Reform Law Do in the First Year? discusses how health reform will help people with pre-existing conditions, young adults, people on Medicare, small businesses, community health centers, and others in its first year. (April 2010)

Help Is on the Way: 12 Reasons to Embrace Health Reform discusses key improvements in the new health reform law, including clamping down on insurance company abuses, offering tax credits to small businesses, expanding Medicaid, and improving Medicare. (March 2010)

For a complete list of Families USA's publications on the uninusred, go to Publications by Topic.

From Families USA and Small Business Majority:

A Helping Hand for Small Businesses: Health Insurance Tax Credits analyzes the health reform provision that provides tax credits to small employers to help them buy health coverage for their workers. This report, which was commissioned along with Small Business Majority, provides national and state-level data on the number of small businesses eligible for the credit in 2010, as well as the number eligible for the maximum tax credit. (July 2010)

From the Alliance for Health Reform: 

Health Care after the Supreme Court Decision: What’s Next? answers the following questions: How many states will be ready to run exchanges? Is the federal government prepared to administer exchanges in states without one? What does the court’s ruling mean for people without insurance? And will some states continue to delay implementation efforts until after the November elections? (July 2012)

Trends in Health Insurance Coverage in the U.S.: The Impact of the Economy discusses how states are responding to the challenge of insuring the uninsured, what assistance the federal government has provided, and how and when health reform will address these issues. (December 2010)

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 American Progress:

Unraveling Reform Would Leave Millions with Less Affordable Care discusses recent efforts by attorneys general in 14 states to challenge the newly passed health reform law. The brief also presents data on the percentage of each state’s population that will benefit from coverage expansions, which show that many of these attorneys general represent states that have the most to gain from health reform. (March 2010)

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:

Uninsured Rate Fell or Held Steady in Almost Every State Last Year, New Census Data Show breaks down state-level Census data to show that the decline of residents who are uninsured is largely a result of increased private coverage for young adults and increased enrollment in Medicaid and the Children’s Health Insurance Program (CHIP). (September 2012)

Health Reform Law Makes Clear that Subsidies Will Be Available in States with Federally Operated Exchanges explains that the idea that premium tax credits will not be available to consumers in states with federally operated exchanges is incorrect. It cites sections of the Affordable Care Act that indicate that the federally facilitated exchanges will need to adhere to the same requirements as state-based exchanges, and it argues that it would be inconsistent with the purpose of the law to limit the availability of tax credits to people in certain states. (July 2012)

Childless Adults Who Become Eligible for Medicaid in 2014 Should Receive Standard Benefits Package explains that, while health reform allows states to provide newly eligible people with either regular Medicaid benefits or a less comprehensive package (comparable to private insurance), uninsured, childless adults tend to have greater health needs and would be best served by a more comprehensive package. Given that the federal government will pick up the vast majority of the costs of this expansion, it should be a viable option for states. (July 2010)

Health Reform Expands Medicaid Coverage for People with Disabilities explains why Medicaid, rather than private insurance, is often a better option for people with disabilities or chronic conditions, given its affordability and comprehensive benefits. (July 2010)

Medicaid Expansion in Health Reform Not Likely to “Crowd Out” Private Insurance finds that the expansion will overwhelmingly provide coverage to people who would otherwise be uninsured, rather than shift people with private coverage into Medicaid. The analysis shows that fears about “crowding out” private insurance are exaggerated and inconsistent with past experiences with similar expansions. (June 2010) 

Making Health Care More Affordable: The New Premium and Cost-Sharing Credits explains what these credits are, who is eligible for them, how much they’re worth, and how they can be used. (May 2010)

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:

Health Care in the 2012 Presidential Election: How the Obama and Romney Plans Stack Up compares the potential outcome of the two candidates’ plans with respect to the following: the number of Americans with health coverage, affordability of coverage, consumer protections, consumer choice, help for small businesses, improvements to Medicare, health care quality, and controlling growth in health spending. The report finds that the Affordable Care Act would likely outperform Romney’s proposals in each of these areas. (October 2012)

Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help finds that one-quarter of adults aged 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. It also explains how the Affordable Care Act’s Medicaid expansion and exchanges will help people maintain coverage. (April 2012)

When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help discusses the difficulty people face finding and paying for insurance if they lose their jobs. Although the Affordable Care Act will provide affordable insurance in 2014, this report suggests that policy makers should help the recently unemployed now by offering COBRA subsidies or extending unemployment benefits. (August 2011)

Help on the Horizon: How the Recession Has Left Millions of Workers without Health Insurance, and How Health Reform Will Bring Relief examines the effect of the recession on the health coverage of adults between the ages of 19 and 64 and the implications for both their finances and their access to health care. The Affordable Care Act will greatly reduce the impact on health coverage and will protect workers from becoming uninsured. (March 2011)

Adults Ages 50-64 and the Affordable Care Act of 2010 describes the provisions that adults in this age group will benefit from the most, including the pre-existing condition insurance plan, the expansion of Medicaid eligibility, and the creation of exchanges and premium subsidies for people with low and moderate incomes. (December 2010)

Pre-Existing Condition Insurance Plans Created by the Affordable Care Act of 2010 examines eligibility, benefits, premiums, cost-sharing, and oversight of the pre-existing condition insurance plan programs, as well as variation of the plans from state to state. (October 2010)

Young Adults and the Affordable Care Act of 2010 discusses the provisions that will benefit young adults, including the ability to stay on a parent’s health plan until age 26, the Medicaid expansion, and subsidies in the exchanges. More than 12 million young adults may gain subsidized coverage by 2014, and 7.2 million may gain coverage under Medicaid. (October 2010)

Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010 looks at how women will benefit from provisions that improve coverage and reduce premiums, eliminate pre-existing condition exclusions, eliminate gender rating, and others. Given that women, on average, use more health services over their lifetimes, the new law is likely to greatly improve women’s experience with the health care system. (July 2010)

Rite of Passage: Young Adults and the Affordable Care Act of 2010 discusses provisions in the new law that will help young adults gain health coverage. Key provisions include dependent coverage up to age 26, a Medicaid expansion, new health insurance “exchanges,” and subsidies to help people purchase private insurance. (May 2010)

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 Consumers Union:

Addressing Barriers to Online Applications: Can Public Enrollment Stations Increase Access to Health Coverage? discusses the use of computers or kiosk stations in public places to make online applications more accessible. It identifies challenges and opportunities that policy makers need to understand as they design effective online application systems. (November 2011)

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 Demos and Young Invincibles:

The State of Young America: Health Care and Coverage describes the difficulties young adults face in obtaining health insurance and paying for medical services. It notes that provisions of the Affordable Care Act have started to reverse the trend of rising uninsurance among young adults. (November 2011)

From the Department of Health and Human Services:

Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million finds that the gains in coverage for young adults were almost entirely from increases in private insurance. It also notes that coverage gains for young men, who previously had the highest rates of uninsurance of any gender-age group combination, were particularly large. (June 2012)

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 Enroll America:

Ten Ways to Make Health Coverage Enrollment and Renewal Easy outlines enrollment best practices that can guide policy decisions in any state to maximize the number of people who are quickly and easily enrolled in coverage. (August 2011)

Using Electronic Data to Make Enrollment Easier: A Closer Look at Utah's eFind System examines how Utah gathers readily-available electronic data from federal, state, and local databases to better determine applicant eligibility and streamline enrollment in public programs. (August 2011)

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:

Employment-Based Health Benefits: Trends in Access and Coverage, 1997—2010 provides data on the offer, coverage, and take-up rates among workers. It also examines why many workers are not covered, and it includes breakdowns by age, gender, and race/ethnicity. (April 2012)

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 Uninsured: A Primer presents basic information about the uninsured, including who they are and why they do not have health coverage. The brief also describes how the health reform law will expand coverage to a majority of those who are currently uninsured. (December 2010)

Expanding Medicaid to Low-Income Childless Adults under Health Reform: Key Lessons from State Experiences uses interviews with officials and experts from across the country to help inform efforts to expand Medicaid to childless adults. Key findings include that their limited connection to public programs, fluctuating incomes, and language and cultural barriers all serve as challenges to reaching and enrolling childless adults. (July 2010)

Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL shows that the planned Medicaid expansion will greatly increase coverage, and the federal government will pay the majority of the new cost. Any increases in state Medicaid spending will be small compared to  what states would have spent without reform. (May 2010)

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:

After the Ruling: A Consumer’s Guide is a user-friendly explanation of how the Supreme Court’s decision will affect people without insurance, consumers who get insurance through their jobs, people who want insurance but cannot afford it, people with health problems, small business owners, and seniors. It also explains parts of the law that are already in place. (June 2012)

Mapping the Effects of the ACA’s Health Insurance Coverage Expansions allows you to enter a zip code and get an estimate of the share of the population in that region that will benefit from the Affordable Care Act through either Medicaid or tax credits for private insurance in the exchanges. (February 2012)

Explaining Health Reform: Uses of Express Lane Strategies to Promote Participation in Coverage discusses how these strategies could significantly aid states’ implementation of the coverage expansion under health reform; create the most consumer-friendly user experience possible; and optimize the investment of public dollars in modernized, efficient enrollment systems that support the vision of the Affordable Care Act. (July 2011)

Health Insurance Exchange Development: Innovation in the States is a video of panel discussions with state leaders and stakeholders that explores states’ progress on implementing the exchanges; it also identifies next steps. A podcast is also available. (July 2011)

How People Get Health Coverage under the Affordable Care Act Beginning in 2014 is an easy-to-use flow chart that explains how different people will get coverage under the health reform law based on their income level and job status. (March 2011)

Getting Connected: Can the ACA Improve Access to Health Care in Rural Communities? provides an overview of the provisions in the new law that will benefit rural communities, focusing on provisions that are designed to increase the health care workforce and encourage cooperation between rural health providers and urban medical centers. (October 2010)

Explaining Health Reform: Questions about the Temporary High-Risk Pool describes the pool and answers basic questions about  who is eligible, what benefits will be provided, how much coverage will cost; and when it will go into effect. (July 2010)

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 the Kaiser Health News and USA Today:

Health Insurers Deny Coverage to Many Who Apply for Individual Policies discusses state-specific denial rates that are now available on www.healthcare.gov. In 2014, insurers will no longer be allowed to deny consumers based on health status, but until then, the denial rates are useful tools for consumers who are selecting an insurer. (September 2011)

From Mathematica:

Healthy Indiana Plan: Lessons for Health Reform describes Indiana’s coverage option for low-income, working adults. The brief discusses the plan’s innovative features and assesses early experiences with enrollment and cost-sharing, providing useful insight to policy makers who are considering options for expanding coverage under the Affordable Care Act. (January 2011)

How Does Insurance Coverage Improve Health Outcomes? finds that health coverage improves outcomes by helping people obtain preventive care and other services, and by improving the continuity of care. Coverage can also improve social and economic well-being by averting developmental problems in children, increasing workforce productivity, decreasing the use of hospital services, and reducing costs for public programs. (April 2010)

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:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

The ACA and Health Disparities examines provisions of the Affordable Care Act that seek to address health disparities by improving data collection, prevention of chronic illnesses, workforce development, and health care quality. Unfortunately, the law does not guarantee that funding will be available to implement these provisions. (July 2011)

Nonprofit Hospitals and Community Benefit describes the criteria for obtaining nonprofit status, the problems with the current system, and the legislative and regulatory changes that have been introduced to address those problems. It also suggests opportunities for advocates to use these new tools to advance the health rights of low-income uninsured and under-insured patients. (July 2011)

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:

Why the Individual Mandate Matters compares estimates of what the cost of coverage for the nonelderly would be under the Affordable Care Act with and without the individual mandate. The findings include that the number of uninsured would be cut by more than half with the mandate and by only 20 percent without it, and that government funds that are used to reduce the number of uninsured would be used more efficiently under the mandate. (December 2010)

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:

The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (March 2012)

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:

Consider Savings as Well as Costs: State Governments Would Spend at Least $90 Billion Less with the ACA than without It from 2014 to 2019 presents national and state-level estimates of the costs and savings that will result from health reform. While there would be considerable variation in costs and savings by state and region, the law will reduce state spending on such items as uncompensated care and care for individuals with mental illness. (July 2011)

Swimming Upstream: Improving Access to Indigent Health Care in the Midst of Major Economic Challenges discusses San Mateo County’s initiative to improve access to high-quality care for uninsured and underinsured adults, and it offers lessons to local and national policymakers on how to make progress despite financial obstacles. (December 2010)

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)

From the Urban Institute and the Robert Wood Johnson Foundation:

How Will the Patient Protection and Affordable Care Act of 2010 Affect Young Adults? describes how different elements of health reform will help young adults, specifically the Medicaid expansion, subsidies for private insurance, the expansion of dependent coverage, and insurance market reforms. (July 2010)

Will the Patient Protection and Affordable Care Act of 2010 Improve Health Outcomes for Individuals and Families? discusses how the new law’s expansion of access to insurance, and thereby access to effective medical services, can improve health. In addition to increasing coverage, the new law expands preventive and wellness care and institutes other reforms designed to improve health care quality and in turn, improve health outcomes. (July 2010)

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)

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