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July 2009 St@teside

New SCI Papers on State-Based Small Group Market Reforms

The State Coverage Initiatives program is jointly publishing two papers on state coverage expansions in the small group market with the Engelberg Center for Health Reform at Brookings.  States have focused significant attention on their small group markets in an attempt to influence both the type of coverage purchased and the affordability of insurance options.  These papers discuss the policy choices and dilemmas states face, and highlight on recent state innovations devised in response to those challenges.

State Reform Efforts in the Small Group Market: Past, Present and Future” explores recent state innovations, including “wellness plans,” negotiating directly with insurance plans on price and benefit design, encouraging the use of Section 125 plans, health insurance exchanges, and first-dollar coverage.  It highlights the elements that characterize successful programs, including sufficient subsidies, effective collaboration with stakeholders, simple program design, and an emphasis on outreach and marketing.  It also explores several dilemmas states face, including whether to allow individuals to enroll in small group programs without their employers and whether or not to provide subsidies to those already offering coverage.

Evolving State Approaches to Expand Coverage in the Current Wave of State Access Reform” looks at the experience of small group market programs in four states: Arkansas, Tennessee, Massachusetts and Washington.  Through research on small group markets throughout the country and using the example of these four states, the paper attempts to answer the following questions: 

  • What common challenges characterized earlier state efforts targeting small firms and individuals?
  • How are state initiatives in today’s “new wave” of access reforms adapting and improving on past models?
  • What are the implications of these models for other state or national proposals for expanding access in the small and non-group markets?