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New England Public Policy Center
Research Report No. 07-1
by Alicia Sasser
Full-text paper 
As the number and percentage of people without health insurance
continues to climb, the goal of expanding such coverage is
even more pressing. Traditional strategies have had only limited
success. And with little movement at the federal level, states
have chosen to enact their own bold initiatives. Four New
England states - Maine, Massachusetts, Rhode Island, and Vermont
- have recently passed or implemented programs to expand health
insurance coverage, some with the goal of achieving near-universal
coverage. By combining different strategies from across the
political spectrum, the new initiatives represent a unique
amalgam approach to expanding health care coverage. This paper
examines existing strategies that have taken a more incremental
approach to expanding coverage and also explores the new initiatives
in New England, comparing and contrasting their designs and
strategies.
Over the past decade or so, states have had varying degrees
of success in pursuing a number of traditional strategies,
often in combination, to achieve incremental reductions in
the rate of uninsured. Policies targeting the low-income population,
such as Medicaid and SCHIP expansions, have been modestly
successful in expanding coverage at a fairly low cost. Yet
efforts to address the high-risk population and policies to
expand coverage in the individual and small group markets
have had limited success.
In contrast to previous efforts to expand coverage, the new
insurance initiatives in New England emphasize "shared
responsibility," placing the onus for coverage on government,
employers, and individuals alike. Several of the plans provide
public subsidies to ensure affordability for low-income residents.
Two states also impose financial penalties on employers that
do not offer health insurance coverage. To encourage individual
participation, most of the plans offer fairly comprehensive
coverage, with relatively limited cost sharing. Massachusetts
has gone further, mandating that individuals purchase coverage,
either from the state, through their employer, or in the private
market.
Yet, the New England states face various pitfalls as they
expand coverage. For example, in setting subsidies for individual
premiums, policymakers must balance the need to make coverage
affordable with the desire to minimize the potential for disruption
in the group insurance market. Another challenge is to maintain
minimum benefits standards while negotiating premium discounts
with insurers, a task that may prove difficult in the future
if the new programs are unable to attract a sufficiently large
share of the market. Finally, many of the new programs rely
on cooperation between states and insurers, which can be difficult
to sustain over time, especially in states with few players
in the private market.
Full-text paper |
