low income health insurance washington state

Urban Institute: Health Policy
Urban Institute reports from: Health Policy - The Urban Institute is a nonprofit nonpartisan policy research and educational organization established to examine the social, economic, and governance problems facing the nation.

• 2008 Massachusetts Health Insurance Survey Methodology Report
  The Urban Institute, along with its subcontractor, International Communications Research, conducted the 2008 Massachusetts Health Insurance Survey (HIS) for the Massachusetts Division of Health Care Finance and Policy to obtain information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report provides information about the methods used to collect and analyze the 2008 HIS data.
• Health Insurance Coverage in Massachusetts : Estimates from the 2008 Massachusetts Health Insurance Survey
  The Urban Institute, along with its subcontractor, International Communications Research, conducted the 2008 Massachusetts Health Insurance Survey (HIS) for the Massachusetts Division of Health Care Finance and Policy to obtain information on health insurance coverage and access to and use of health care for the non-institutionalized population in Massachusetts. This report summarizes the results of that new survey, including the finding that more than more than 97 percent of Massachusetts residents have health insurance, with only 2.6 percent of state residents remaining uninsured.
• Medicaid and Entitlement Reform
  The commentary responds to a recent report from the Centers for Medicare and Medicaid Services (CMS) on future Medicaid spending growth. Medicaid spending growth will in fact be high but not probably as high as the CMS actuaries have forecast (7.9% per year). The evidence on Medicaid spending growth suggests that spending per enrollee in the Medicaid program has been held down to levels consistent with the medical care CPI and increases in GDP. The main cost driver has been enrollment growth - hard to address when the number of uninsured is rising. Further spending restraint could come from more efficient care for Medicaid's dual eligibles.
• State Buy-In Programs: Prospects and Challenges
  State buy-in programs are designed to address coverage shortfalls among moderate- and higher-income children whose families are not eligible for Medicaid or SCHIP but who cannot afford, or do not have access to, private coverage. These programs allow families to buy their children into a comprehensive public insurance plan with low out-of-pocket cost sharing at an unsubsidized premium. As more states aim to achieve universal coverage for children, buy-in programs may be one component they consider in their plans to reach that goal. This brief explores some issues for states to consider before implementing a buy-in program.
• Parents' Opinions of the Los Angeles Healthy Kids Program Remain High Despite Recent Challenges : Findings from the Second Evaluation Focus Groups
  A second series of focus groups with parents of children enrolled in the Los Angeles Healthy Kids program found that opinions of the program remain favorable despite its recent fiscal challenges. Healthy Kids had provided comprehensive, affordable coverage to nearly 45,000 poor children from birth through age 18 until mid-2005, but funding shortfalls led the program to cap enrollment for older children and enrollment levels for all children subsequently slipped. Still, the program remains highly valued by parents for providing high quality, comprehensive coverage and parents report good access to linguistically appropriate care and affordable out-of-pocket costs.
• Growing Pains for the Los Angeles Healthy Kids Program
  The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture.
• Level Playing Fields and Inconsistent Rules: A Risky Combination
  Small employers cannot buy health insurance unless 75 percent of workers offered coverage enroll. Under Senator McCain's proposal to replace the tax exclusion for employer-sponsored insurance (ESI) with tax credits usable for ESI or non-group plans, many young and healthy workers would save money by shifting from ESI to non-group coverage; non-group plans typically lower premiums for healthy enrollees. Some employers could no longer meet participation requirements and would become unable to buy group insurance. Many of their employees would involuntarily lose ESI, forcing them into the non-group market, where older workers and those with health problems may fare poorly.
• Targeting Subsidies: Employers versus Individuals
  Recent congressional proposals and reforms advocated by the presidential candidates have renewed the debate about whether the problem of the uninsured is best addressed through subsidies to employers or to individuals. In this brief, the authors argue that it is more efficient to provide subsidies directly to individuals and families than to employers. Individual subsidies will lead to less displacement of private spending and will be more equitable. Employers have limited information about their workers, making employer subsidies more difficult to target to individuals with the greatest needs. In addition, employer subsidies do not eliminate the need for individual subsidies.
• Who Gained the Most Under Health Reform in Massachusetts?
  We know that health insurance coverage rose dramatically in the past year in Massachusetts. This study examines what the effect has been on specific populations, finding that the greatest gains in insurance coverage were reported by lower-income adults, younger adults and those in minority groups. Further, the reductions in uninsurance tended to be largest for subgroups that started out with higher levels of uninsurance.
• Impact of Health Reform on Underinsurance in Massachusetts : Do the Insured Have Adequate Protection?
  Although health insurance coverage rose dramatically in the past year in Massachusetts, some questioned whether health reforms simply moved people from being uninsured to underinsured. This study explores whether requiring individuals to have health insurance has forced some people, particularly those with modest incomes, into plans that offer little financial protection. The findings suggest, however, that health reform in Massachusetts is both providing new coverage for many of those who were previously uninsured and improving the quality of coverage for those with insurance coverage.
• Can a Public Insurance Plan Increase Competition and Lower the Costs of Health Reform?
  Senator Barack Obama, along with others, has proposed developing a public plan that would compete with private insurers within an organized health insurance marketplace. The argument is that a public plan would have lower administrative costs and more ability to control provider payment rates. This paper assesses these arguments concluding that there would be administrative cost savings and lower provider payment rates but not as much as is often asserted. Strong private insurers that offer good value for premiums charged would survive. But most important, the amount of real competition in both insurance and hospital markets would be enhanced.
• An Analysis of the McCain Health Care Proposal
  The McCain health care plan represents a philosophical advance over many proposals, principally in its commitment to redistributing the current tax exemption for employer-based health insurance. However, the plan raises more concerns than it addresses.McCains proposal would dramatically change how many obtain insurance, make coverage less accessible for those with health problems, have a high budget cost, but have little effect on the number uninsured.These problems could be addressed by providing a guaranteed source of adequate, affordable coverage; phasing-out the tax exemption slowly; larger subsidies to the low-income; spreading health risk broadly; and a significant commitment to cost-containment.