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.
Covering the Uninsured: Costs, Benefits, and Policy Alternatives for New England. This December 2006 conference featured the research profiled above and convened a select group of key stakeholders including policymakers, insurers, hospital administrators, employers, public health advocates, and health policy researchers from across all six New England states and the nation.
The Challenge of Sustaining Health Care Reform in Massachusetts. Co-sponsored with Harvard University's Rappaport Institute for Greater Boston, Taubman Center for State and Local Government, and Program for Health Systems Improvement, this May 2009 conference investigated challenges to sustaining health reform in the Commonwealth, including reducing costs and improving the value of healthcare.
Nurse-to-Patient Ratios: Research and Reality. Co-sponsored with the Massachusetts Health Policy Forum at the Heller School of Brandeis University, this conference focused on whether government should mandate nurse-to-patient ratios in hospitals and what the potential impact of such ratios would be. May 2005.
Small Employers and
Expanded Health Insurance Coverage
by Phil Primack
NEPPC Policy Brief 07-5
Who Are the Uninsured,
and Why Are They Uninsured?
by Antoniya Owens
NEPPC Policy Brief 07-3
The Value Of Antihypertensive Drugs: A Perspective On Medical Innovation,” Alicia Sasser, David M. Cutler, Genia Long, Ernst R. Berndt, Jimmy Royer, Andrée-Anne Fournier, and Pierre Cremieux. Health Affairs. vol. 26, no. 1 (2007): 97-110.
Covering the Uninsured:
Costs, Benefits, and Policy Alternatives for New England
by Matthew Nagowski
NEPPC Conference Series Report 06-1
Care Employment across New England and the Nation
by Alicia Sasser and Matthew Nagowski
NEPPC Memo (2006)
of Current Proposals for Massachusetts Health Care
by Heather Brome
NEPPC Memo (2006)
To review other Center research about health policy, please visit our research index.
Fiscal Challenges on the Horizon: Expanding Health Insurance Coverage in New England (Transcript) Fifth Annual New England Public Finance Conference (October 22, 2007)
Extending Health Care Coverage in New England
National Tax Association Meetings (November 16, 2006)
Reaching the Goal:
Evaluating Policy Alternatives for
Presented at: “Covering the Uninsured: Costs, Benefits, and Policy Alternatives for New England” NEPPC Policy Forum (December 5, 2006)