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September 2007

New Publication on Efforts to Expand Coverage to the Uninsured

The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, contracted with AcademyHealth to study the practical experiences of a select group of states that have implemented affordable private and public coverage insurance products for low-income workers. AcademyHealth partnered with the Center for Health Program Development and Management at the University of Maryland, Baltimore County to conduct the study.

The study, Efforts to Expand Coverage to the Uninsured: Program Design Challenges and Tradeoffs in Six States, includes an in-depth assessment of programs in six states—Arizona, Michigan, New Mexico, New York, Oklahoma, and Utah—to gain a better understanding of the design elements associated with successful programs.

This paper compares and contrasts the different approaches that states take to address this issue in four broad areas.

  1. Program Design - how states targeted their programs in terms of size of employers, income eligibility standards, and type of delivery system (e.g., managed care).
  2. Program Financing - the variation in the relative roles of states, employers, and employees in paying for the products and the constraints that Medicaid funding introduces into program operations.
  3. Methods to Keep the Program Affordable - how programs control costs by limiting the services or implementing co-pays and other cost sharing provisions.
  4. Program Administration - the different approaches states have taken to manage and promote these programs.

The main body of the report concludes with a section on lessons learned. As the number of uninsured continues to grow and as employer-sponsored insurance rates decline, individual states have stepped in to help improve access to insurance.