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Study: Expanding Public Health Programs Would Cover Many Uninsured

JUNE 8, 2005 -- Expanding public programs to cover low-income adults and children could help reduce the number of uninsured in many states, according to a recent study from Columbia University.

The report, published as a Web Exclusive by the journal Health Affairs, concludes that there is no one solution for expanding federal health coverage across all 50 states. What could reduce the uninsured rate by 20 percent in some states would have little effect in others.

Authors Sherry Glied and Douglas Gould compared the impact of five separate proposals, including President George W. Bush's proposed tax credit to low-income individuals and families. In states with high insurance premiums, Bush's plan would result in a 4.4 percent decline in uninsured rates, while in others the rate would decrease by up to 20.5 percent. Overall, the national uninsured rate would decrease by 1.7 percent.

Expanding the eligibility for State Children's Health Insurance Programs (SCHIP) in families below 300 percent of the federal poverty level could decrease uninsured rates by 18 percent in some states, but do little in states that have already expanded eligibility. Further expanding coverage to these children's parents would have up to a 4.7 percent impact.

Broadening eligibility for Medicaid to include adults 133 percent below the poverty line would create significant reductions in the most states, with the highest reduction at 10.3 percent. And though these adults are already covered in some states, the researchers say federal funding for this insurance proposal could ease state budget problems.

"The message is that there is no single solution that will work for all the uninsured, so we need a variety of solutions. In some states the problem of the uninsured is related to the high cost of health insurance, and in other states it is more closely linked to high rates of poverty among the uninsured," said a statement from Glied, professor in the Department of Health Policy and Management of Columbia's Mailman School of Public Health. "Federal policies to increase health insurance coverage would be more effective if they took into account the variety of economic structures, insurance markets, and the situations of uninsured individuals across states."

In terms of capturing the greatest group of those uninsured nationally, expanding SCHIP is most effective, with 11.5 percent of Americans currently uninsured gaining coverage under the proposal. The president's plan is second, giving insurance to 11 percent, and expanding Medicaid would cover 5.2 percent of the uninsured population.

The article was published with support from The Commonwealth Fund, a private foundation supporting independent research on health and social issues.

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