Due to rising health care costs, a weak labor market, and a growing number of uninsured Americans, health care reform became a major issue in the 2004 presidential campaign. Fund staff released a series of reports and issue briefs that informed policymakers, the media, and the public on the dimensions of the problem and strategies that could expand coverage and make it more affordable. In October 2004, Fund senior program officer Sara Collins, Ph.D., president Karen Davis, Ph.D., and colleagues published an issue brief based on the Commonwealth Fund Biennial Health Insurance Survey documenting the lack of health benefits and sick leave among low-wage earners and the implications in terms of access to care and medical bill problems.(1)
Also in that month, Collins, Davis, and grantee Jeanne Lambrew, Ph.D., published the final version of Health Care Reform Returns to the National Agenda: The 2004 Presidential Candidates Proposals
which compared the various cost estimates of President Bush's and Senator Kerry's health plans. Both studies were frequently cited in the press leading up to the election, as were data from the original survey report, The Affordability Crisis in U.S. Health Care.(3)
After the election, the program continued to inform and advance the debate over health insurance reform. Timely analyses of initiatives implemented or championed by the Administration and Congress provided crucial information about the ability of these new policies to reduce the uninsured rate, enhance access to affordable care, or lower insurance costs to workers and businesses.
One such initiative is the Health Coverage Tax Credit Program, enacted as part of the 2002 Trade Act. Designed to help make insurance coverage more affordable to workers displaced by globalization, the program has been closely studied by Fund grantee Stan Dorn, J.D., of the Economic and Social Research Institute. In two papers published by the Fund in April and October 2005, Dorn and colleagues reported that despite a promising start, the program has been unable to enroll eligible individuals at the rate expected, primarily because the premiums charged by health plans are too costly for many unemployed workers.(4)
Dorn suggests a number of ways that future expansion policies based on tax credits might be designed to realize higher enrollment, including subsidizing premium payments so that enrollees can afford them, providing access to health plans that cover preexisting conditions, and simplifying what can be a burdensome application process.(5)
Both the Administration and Congress have drawn from this research in their efforts to improve the program.