Health care reform is near the top of the nation's policy agenda for the first time in over a decade, driven by turmoil in the private insurance markets and state public insurance programs. Reform strategies were proposed by nearly all of this year's presidential candidates as well as Democratic and Republican members of Congress, private sector groups, and leading academics. The Task Force helped inform the debate by offering policy options for achieving universal coverage and strategies to control health care costs.

The universal coverage framework offered by Fund president Karen Davis and vice president Cathy Schoen in their 2003 Health Affairs article, "Creating Consensus on Coverage Options,"⁽¹⁾ proved useful to candidates in shaping their platforms. The "Creating Consensus" framework, which builds on existing group insurance options such as the Federal Employees Health Benefits Program, is intended to help bridge differences between public and private approaches to health insurance reform. The Task Force also made an impact with its examination of the presidential candidates' reform plans, which included a comparison of coverage and cost estimates.⁽²⁾ The study, which was updated at key junctures throughout the campaign, became an important resource for the public and the press; in fact, report downloads from the Fund's Web site exceeded 40,000.

In the post-election era, the Task Force will continue to inform and advance the debate over health insurance reform. Timely analyses of initiatives recently implemented or championed by the Administration and Congress will provide crucial information about their ability to reduce the uninsured rate, enhance access to affordable care, or reduce insurance costs to workers and businesses. One such initiative is the health coverage tax credit program enacted as part of the 2002 Trade Act. The program, designed to help workers who have been displaced by globalization buy health insurance, has been the focus of recent work undertaken by Fund grantee Stan Dorn of the Economic and Social Research Institute. At an April 2004 congressional briefing, Dorn reported that despite technical achievements in issuing the credits, enrollment in the program has been lower than expected, primarily because health plan premiums are too costly for many unemployed workers.⁽³⁾ Both the Administration and Congress have relied on Dorn's research findings to explore ways to expand the tax credit's impact. The Task Force is now supporting Dorn's evaluation of the program's second year of operation.

Association health plans, which are offered by some professional and trade associations, have also been advanced as a way for small employers to purchase affordable health insurance coverage. Some proposals would allow these plans to bypass state insurance regulations, including reserve requirements. In her work, Task Force grantee Mila Kofman of Georgetown University revealed the pitfalls of such plans. Kofman found that the bankruptcies of unauthorized health plans, including association plans, have left nearly 100,000 people with approximately $85 million in medical debt since 2001.⁽⁴⁾ In invited testimony before a hearing held by Senator Charles Grassley, Kofman called for stronger criminal penalties against such insurance scams.

In related work, Kofman documented the insolvency risks with association health plans and similar insurance arrangements and recounted the experience of some states that have tried to regulate these plans.⁽⁵⁾ Kofman's new work will focus on the financial protection provided by insurance discount cards.