A weak labor market and the continuing erosion of health insurance have sparked new calls for comprehensive health insurance reform during the past year. The Task Force contributed to the momentum by developing a proposed framework for a more automatic, affordable health insurance system for Americans under age 65 that would build on existing forms of public and private coverage. The framework was presented in an article⁽¹¹⁾ in Health Affairs, "Creating Consensus on Coverage Choices," in which Fund coauthors Karen Davis and Cathy Schoen laid out a comprehensive blueprint for near-universal coverage. The framework allows for incremental insurance expansions, phased in over time. Key elements have subsequently appeared in the position papers of several presidential candidates.⁽¹²⁾

With millions losing coverage due to job loss and intense pressure on public budgets, policy leaders also continue to look for strategies to expand insurance one step at time. A report by Jeanne Lambrew and Arthur Garson, Jr., M.D., outlined a dozen policy options that, for roughly $1 billion each, would provide sub-groups of uninsured and underinsured Americans with access to private or public health coverage.⁽¹³⁾ Although not a substitute for comprehensive reform, the policies would provide badly needed insurance to workers changing jobs, small business employees, and others at relatively modest cost.

One step forward would be to help uninsured young adults. An analysis by Sara Collins and Fund colleagues found that nearly two in five college graduates and half of high school graduates not attending college were uninsured at some point during the first year after finishing school.⁽¹⁴⁾ Extending parents' policies to young adults through age 23, letting low-income young adults stay on CHIP or Medicaid past age 19, and mandating college-based insurance would sharply reduce the number of uninsured young adults and enhance insurance continuity during the transition from dependence to independence. The report helped spark interest among members of Congress and state lawmakers in legislation to close coverage gaps affecting low-income adults.

Low-wage workers are at particular risk of being uninsured or under-insured. An issue brief⁽¹⁵⁾ by Task Force staff revealed that workers earning less than $10 per hour in both large and small firms are notably less likely to have access to job-based coverage and often face barriers to participation even when coverage is offered. A recent analysis⁽¹⁶⁾ of state coverage patterns by Randall Bovbjerg and Jack Hadley further found that Medicaid provides minimal support for low-income working adults, and that public programs for working adults vary widely by state. Noting the cyclical nature of enrollment, the authors recommend greater counter-cyclical subsidies to states in times of economic downturn.