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Addressing the Needs of the Uninsured in a Challenging Economic Environment
Slide Presentation by Vickie S. Gates
On March 13, 2002, Vickie S. Gates made a presentation in a Web-assisted teleconference at Session 2, which was entitled "State and Local Efforts to Close the Gaps between Public and Private Insurance Coverage."
This is the text version of Ms. Gates' slide presentation. Select to access the PowerPoint® slides (434 KB).
State and Local Efforts to Close the Gaps between Public and Private Insurance Coverage
Vickie S. Gates
Academy for Health Services Research and Health Policy
The Robert Wood Johnson Foundation's
State Coverage Initiatives Program
Current State Environment
- Reduced revenues.
- Expenditures over budget.
- Rising Medicaid caseloads.
- Rising health care costs.
- Maintenance, low and no cost options.
- November elections (36 Governors).
State Options to Expand Health Care Coverage
- Public programs, including new Medicaid options.
- Public-private partnerships.
- Market based reforms/strategies.
Public Program Options
- Medicaid 1931.
- 1115 Demonstration Waivers.
- State Children's Health Insurance Program (SCHIP).
- Health Insurance Flexibility & Accountability (HIFA).
Closing the Gap Between Public and Private
- High risk pools.
- Programs to improve employer offer rates.
- Premium subsidies for employees.
- Full cost buy-ins and pools.
Major Obstacles to Expansion
- Funding and fear of commitment.
- Benefit design, cost sharing for existing and expansion populations.
- Increasing costs.
- Provider support and participation.
- Administrative complexity, low participation ESI (HIFA may help).
State Research Needs
- What is affordable coverage?
- Understanding employer decisions .
- Uncompensated care and the safety net.
- Link between health insurance and health status.
Insights and Lessons
- No silver bullet; multiple strategies.
- Shifting resources between populations is extremely difficult.
- "Right" benefit design and cost sharing are research and political issues.
- Uninsured still stereotyped; lack political leverage.
- Importance of partnerships, collaboration.
State Coverage Initiatives
c/o Academy for Health Services Research and Health Policy
1801 K Street, NW Suite 701-L
Washington, DC 20006
States and Communities
- The "ready" community, the community with special needs, the pilot.
- Community as a health insurance pool.
- Demonstrated success in improving health outcomes at lower cost.
- Ability to reach employers, uninsured, medical community; bring resources together.
HIFA: Plus and Minus
- Benefit and cost sharing flexibility.
- Ability to use SCHIP allotments to meet budget neutrality.
- Responsive, simpler waiver process.
- Mixed State reaction to ESI option.
- Concerns on budget neutrality.
State and Local Efforts to Close the Gaps between Public and Private Insurance Coverage. Slide Presentation by Vickie S. Gates, at Web-Assisted Teleconference, "Addressing the Needs of the Uninsured in a Challenging Economic Environment." Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/uninsuredtele/session2/gatestxt.htm
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