In the past year, the Fund's work has highlighted programs in Maine and New York that aim to expand coverage to small businesses and individuals who are unable to afford the high price of insurance. Katherine Swartz, Ph.D., of the Harvard School of Public Health revisited the Healthy New York program to see how well it was reaching its target population—small businesses and workers who are not offered health insurance—after three years of existence.⁽¹⁾ The program, operating under budget projections and maintaining more than 90,000 enrollees, illustrates that reinsurance can be an effective model in reducing the high cost of coverage, especially when paired with a somewhat limited benefit package. Another reinsurance model in Arizona has also been successful, Swartz found, in dramatically lowering overall program costs.

In Maine, the passing of the ambitious Dirigo Health Reform Act has brought the state national attention. In three reports released this year, researchers from the National Academy for State Health Policy described the overall framework of the Dirigo reforms—intended to achieve universal coverage, cost controls, and quality improvement—analyzed benefit and cost-sharing structures, and discussed the public's perception of the program.^{(2) (3) (4)} Dirigo is notable for its innovative approach, particularly the way in which premiums, deductibles, and copayments are scaled to enrollee income in order to keep total out-of-pocket spending to an affordable level.

With support from competitive grants made by the federal Health Resources and Services Administration, many other states have been collecting data and developing strategies to extend coverage to the uninsured. As reported by Sharon Silow-Carroll and Tanya Alteras, since 2000, 46 states, four U.S. territories, and the District of Columbia have received grants of about $1 million each to develop customized state plans, and eight states and one territory have received grants to design and plan the pilot projects.⁽⁵⁾ In a second report, analysts from the Economic and Social Research Institute reported on the major strategies states are considering. To avoid creating a financial burden for any one sector, many of these approaches seek ways to share costs among employers, consumers, Medicare and Medicaid, and state governments.