State Strategies Work To Expand Health Insurance Coverage

Successful Programs In Oregon, Rhode Island, New Jersey, And Georgia Demonstrate Common Themes Of Leadership And Commitment

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New York City, November 19th, 2002—Faced with inaction on the federal level to stem the rising tide of uninsured, states are carrying out their own innovative programs to increase the number of residents with health insurance coverage. A new report from The Commonwealth Fund profiles such programs in Oregon, Rhode Island, New Jersey, and Georgia, and analyzes elements common to each state's success, including strong leadership and commitment, seamless coverage for disparate groups, and involving providers and consumer advocates in program design. While states have recently faced the challenge of sustaining gains in health insurance coverage due to budget shortfalls, they have also overcome barriers and made significant progress in expanding health insurance, and can provide lessons for other states. "Many states have developed creative strategies to expand health insurance coverage, whether increasing enrollment in or expanding eligibility for public programs, shoring up employer-sponsored coverage, or a combination of these," said Karen Davis, president of The Commonwealth Fund. "The common theme throughout these success stories is leadership in the state, tapping federal funds, and a clear commitment to breaking through barriers that impeded earlier coverage efforts." The report outlines key elements that are common to all four state programs, as well as unique experiences in each state:

  • Importance of Political Leadership and a Clearly Defined Mission—It appears critical to have a strong leader, preferably the governor, adopt coverage expansion as a major priority and "sell" it to the public, legislators, and stakeholders. Each of the states had a strong program champion.
  • Public-Private Partnerships Are Difficult to Sustain—States are having difficulties in forming public-private partnerships as a vehicle for coverage expansion. However, states may benefit from new federal flexibility on expanding employer-based insurance through Medicaid and/or CHIP.
  • Input from Stakeholders Is Valuable—States found that strategies such as soliciting feedback from health plans, and including patient advocacy groups in development of programs were crucial to their success. Public forums were a key part of Oregon's process when developing the Oregon Health Plan.
  • Minimize "Crowd-Out" While Expanding Public Programs—Private programs should be promoted when expanding public programs to avoid the risk of substituting public for private coverage. New Jersey focused on the need to treat families in similar economic situations fairly without giving currently covered individuals or employers incentives to drop private coverage.
  • Build Coverage Under One Umbrella—All four states expanded coverage under one program. This approach appears to help garner public and legislative support, minimize administrative complexity, and allows families to be covered together.
  • Managed Care Capacity—States that rely on managed care should pay attention to attracting and retaining plan participation. States may enhance capacity by nurturing and working with safety net health plans.
  • Federal Matching Funds—States that have been successful have used federal matching funds from Medicaid, CHIP, or waivers to expand coverage to additional populations.
  • Need to Sustain Gains in Difficult Economic Times—States have begun to plan for budget shortfalls by using strategies such as imposing modest premiums (Rhode Island) or proposing a leaner benefit package (Oregon).
"As states face tougher economic times and higher unemployment rates, it is even more important for them to look at creative ways to ensure that more people do not lose their health insurance," said Jennifer Edwards, director of health policy, research, and evaluation for the Fund. The report, Assessing State Strategies for Health Coverage Expansion: Summary of Case Studies of Oregon, Rhode Island, New Jersey, and Georgia, by Sharon Silow-Carroll, Emily K. Waldman, Jack A. Meyer, and Claudia Williams of the Economic and Social Research Institute, and Kimberley Fox and Joel C. Cantor of the Center for State Health Policy at Rutgers University, is based on site visits and interviews with program administrators, policymakers, and representatives from the consumer, business, and health plan/provider communities. It is part of a series on leading states' efforts to cover the uninsured from the Commonwealth Fund Task Force on the Future of Health Insurance. Three additional reports will be released by the end of the year.

Publication Details

Publication Date:
November 19, 2002

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