A slow economy and escalating premiums have triggered a search for more affordable insurance policies, especially among small firms seeking cut rates. A new Fund report⁽²⁴⁾ by Mila Kofman of Georgetown University spotlighted what appears to be a new wave of insurance scams and fraudulent insurance products. Striking a responsive chord in markets across the country, the report was covered by the Wall Street Journal, CNN, NPR, and dozens of local outlets. The report described the efforts of state attorneys general to protect families and employers.

Federal policymakers have expressed growing interest in state-level demonstrations of health insurance expansions. Karen Davis and Task Force member Arthur Garson, Jr., M.D., dean of the University of Virginia School of Medicine, contributed to a special report⁽²⁵⁾ by the Institute of Medicine, Fostering Rapid Advances in Health Care: Learning from System Demonstrations, in which they recommend that the federal government fund demonstrations of between three and five coverage expansion models. The Task Force followed up with a June 2003 forum, sponsored by the Alliance for Health Care Reform, which brought together state and federal leaders and senior policy analysts to advance the concept of federally funded state expansion pilots.

During 2003, several states began to move forward with new policies to improve insurance coverage, even as they grappled with fiscal crises. Maine made national news by enacting legislation to address health care access, cost, and quality. With expert support from several Task Force grantees, the Maine effort resulted in a new public-private initiative known as Dirigo (after the state motto, "I lead"), which would pool coverage for small-business employees, self-employed workers, and low-income working adults and sponsor efforts to improve quality of care.

Other Task Force initiatives emphasized the potential of state strategies to cover the uninsured and improve the quality of care. Case studies⁽²⁶⁾ of ten states that have had early success in expanding coverage, developed by Sharon Silow-Carroll and colleagues of the Economic and Social Research Institute, highlighted a range of valuable strategies. An in-depth case study⁽²⁷⁾ of Minnesota by Deborah Chollet and Lori Achman of Mathematica Policy Research suggests that well-coordinated incremental efforts can be highly effective. Evidence from Rhode Island, described in a report⁽²⁸⁾ by Silow-Carroll, indicates that strategic quality improvement efforts have reduced public program costs and provided measurable health improvements for beneficiaries.

The Task Force built on past efforts to address the particularly acute problems of lack of health insurance and barriers to care among Hispanics. An audience of community leaders, providers, and advocates heard a keynote speech by Surgeon General Richard Carmona, M.D., and a presentation by Congresswoman Hilda Solis, chairwoman of the Congressional Hispanic Caucus Health Care Task Force, at a February 2003 conference, "Lack of Insurance and Quality of Care: A Health Care Crisis for Hispanics," sponsored by the National Hispanic Medical Association with support from the Fund. Analysis by the Fund's Michelle Doty found formidable barriers to health care for people who are uninsured and speak Spanish: two-thirds of uninsured, Spanish-speaking adults have no regular doctor, and almost half report communication problems with their physicians.⁽²⁹⁾ The findings underscored the need to address language and insurance concerns to improve access and quality of care.