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State and Local Initiatives to Enhance Health Coverage for the Working Uninsured


States and local communities can employ a number of strategies to expand health insurance for uninsured working people and their families, according to a new report by The Commonwealth Fund Task Force on the Future of Health Insurance.

State and Local Initiatives to Enhance Health Coverage for the Working Uninsured, by Sharon Silow-Carroll, Stephanie E. Anthony, and Jack A. Meyer of the Economic and Social Research Institute, describes the various ways states and local communities are making coverage more affordable and accessible. Although the authors focus primarily on programs that target employers and employees directly, they also examine a sample of programs targeting a broader population. A few initiatives deal with state efforts to make private insurance plans more accessible to individuals and very small firms, but without subsidizing premiums. Under other programs, states reinsure private health plans to help them reduce the premiums charged to employers and employees. There are also a few examples of managed care and Medicaid expansion programs that make publicly sponsored coverage available to low- and moderate-income people-a group that includes many uninsured workers and their families.

As the study notes, most of the 42.6 million uninsured people in the United States are workers and their family members. A majority of the working uninsured have incomes that place them in the poor or near-poor category, putting them at risk of financial ruin from any type of serious disease, illness, or accident. At the same time, many small firms that operate on a narrow profit margin cannot afford to purchase coverage for their workers or are reluctant to offer coverage to workers who may only be there for a short time.

By compiling information on current state and local initiatives, the authors hope to educate policymakers and others about the variety of alternatives that exist for expanding health coverage for the nation's working families.

Facts and Figures

  • About 34 million people work for an employer that offers no health coverage, and about 14 million of them lack coverage from any source.
  • Approximately 3.7 million people are uninsured because they are ineligible for their company's health coverage, while 2.5 million are uninsured because they choose not to enroll in the company health plan.
  • Only 55 percent of firms with three to 10 employees offered health coverage in 1999, compared with more than nine of 10 firms with 50 or more workers.

Publication Details

Publication Date: November 1, 2000

State and Local Initiatives to Enhance Health Coverage for the Working Uninsured, Sharon Silow-Carroll, Stephanie E. Anthony, and Jack A. Meyer, The Commonwealth Fund, November 2000


President, Economic and Social Research Institute
Principal, Health Management Associates