Executive SummaryThe Economic and Social Research Institute (ESRI) and the Center for State Health Policy (CSHP) at Rutgers University examined the experiences of four states—Oregon, Rhode Island, New Jersey, and Georgia—that have made significant progress in health coverage expansion. The main goal of the project was to determine the key factors that appear essential for success. ESRI and CSHP researchers sought to assess the political, economic, and other “ingredients” that facilitated coverage expansion efforts in each of the states, as well as the barriers and mistakes that hampered those efforts. The underlying question was whether common themes and lessons would emerge from a review of the experiences of these states, despite their different circumstances and strategies.
The research did reveal common themes across all or some of the sites studied, as well as lessons that emerge from individual state experiences. These are highlighted in the report. The overviews of the case studies provide additional information for policymakers and program administrators. The experiences of these states may provide guidance for other states as they consider how to address a growing uninsured population with limited resources and how to prepare for more ambitious initiatives under better economic conditions. The fiscal crises experienced by states in 2001–02 have led many states to consider cutting back Medicaid, State Children's Health Insurance Programs (CHIP), and other health coverage programs, as well as to postpone or cancel plans for further coverage expansions. These temporary setbacks should not obscure the fact that some states have made significant progress in access expansion over the past decade, overcoming myriad obstacles along the way, and remain committed to ensuring that people have access to health coverage.
States have pursued multiple strategies to reduce the number of uninsured. These strategies include increasing enrollment of those already eligible for public programs, initiating CHIP for low-income children, expanding eligibility for public programs to include populations that were previously ineligible (e.g., parents of Medicaid or CHIP-eligible children, adults without dependent children), and shoring up employer-sponsored coverage. Frequently, these state initiatives have been implemented in a piecemeal or incremental fashion, without being integrated into a comprehensive strategy. Several states, however, have tried to develop comprehensive approaches that integrate or at least coordinate multiple strategies in an effort to reach diverse uninsured populations.