Many employers are coping with rising premium costs by offering new insurance products that shift more financial risk to employees. This trend may accelerate with the passage of the Medicare Prescription Drug, Improvement, and Modernization Act and its provision to create Health Savings Accounts (HSAs). These accounts can be used in combination with high-deductible health plans (for example, a plan with a deductible of $1,000 or more for individuals). According to research led by the Health Research and Educational Trust's Jon Gabel, in the next two years up to 30 percent of employees will have a choice of a high-deductible or other type of "consumer-driven" health plan.⁽⁶⁾

The Task Force has tried to clarify what can and cannot be expected from such plans. In September 2003, for instance, the Task Force co-sponsored a conference with the Robert Wood Johnson Foundation at which Karen Davis warned that consumers may skimp on both needed and unneeded care, with low-income patients particularly at risk. Meanwhile, Columbia University researcher and Task Force grantee Sherry Glied is examining the potential of HSAs and high-deductible plans to cover more of the uninsured and their likely impact on group insurance markets.

The Task Force is also training its sights on reform options at the state level. With many states poised to emerge from troubled fiscal times, Task Force members, staff, and grantees are playing an active role in advancing states' coverage expansion initiatives. In a report co-sponsored by the Fund and Robert Wood Johnson Foundation, for example, the National Academy for State Health Policy detailed the development and early achievements of Maine's Dirigo Health Plan.^(7),(8) The plan aims to make quality, affordable health care available to every state resident within five years while initiating new processes for containing costs and improving health care quality. In the year ahead, the Task Force will be keeping close tabs on the progress of Maine's ambitious undertaking.

In February, Karen Davis was invited to attend a health summit sponsored by Governor Kathleen Blanco of Louisiana. The summit resulted in the formation of a health reform panel that was charged with developing a plan to cover the state's 800,000 uninsured residents; the Task Force is supporting the participation of George Washington University's Jeanne Lambrew as a technical expert on the panel. In Kansas, Governor Kathleen Sebelius hopes to develop a new health insurance coverage option for small businesses and their employees in 2005. The Task Force is providing a grant to researchers at the University of Kansas, the Massachusetts Institute of Technology, and Columbia University to help the state of Kansas determine the impact of different combinations of employee subsidies and employer tax credits on the total number of uninsured workers who could be covered through the new option.