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Publications on Health/Healthcare

The Los Angeles Healthy Kids program, during its first four years, extended comprehensive, affordable coverage to over 40,000 poor and vulnerable children, and improved their access to and use of care. Yet, the program also faced serious challenges, primarily related to financing. Funding for children ages 6 through 18 ran short in spring 2005 and Healthy Kids capped their enrollment. State health reform efforts that could have stabilized funding for the program have failed. Based on interviews with over 40 stakeholders, this case study analyzes the complex challenges that the Los Angeles Healthy Kids program faces at this critical juncture.

Small employers cannot buy health insurance unless 75 percent of workers offered coverage enroll. Under Senator McCain's proposal to replace the tax exclusion for employer-sponsored insurance (ESI) with tax credits usable for ESI or non-group plans, many young and healthy workers would save money by shifting from ESI to non-group coverage; non-group plans typically lower premiums for healthy enrollees. Some employers could no longer meet participation requirements and would become unable to buy group insurance. Many of their employees would involuntarily lose ESI, forcing them into the non-group market, where older workers and those with health problems may fare poorly.

Florida is among the first states to implement Medicaid reform using a competitive consumer choice model. Using data from a 2006-07 survey of Medicaid beneficiaries newly enrolled in Florida’s reform program, in an October volume of Health Affairs, Terri Coughlin, Sharon Long and Tim Triplett and colleagues examine how well Florida Medicaid beneficiaries understood the many changes taking place in Medicaid and their experiences in selecting a health plan. They found significant gaps in beneficiaries’ understanding of major components of the reform. Among others, about 30 percent were not aware they were enrolled in reform and more than half had trouble understanding plan information. Additionally, they found that these problems were not particular to any group but instead were experienced broadly across the full Medicaid population.

In April 2006, Massachusetts passed legislation intended to move the state to near-universal coverage within three years, with key components of the reform effort targeting the role of employers. Based on surveys of working-age adults in the state in 2006 and 2007, this paper examines employers’ responses to health reform as reported by their employees. At roughly the end of the first year under health reform, employers in Massachusetts had made few changes in the insurance coverage they offered their workers. Long and Masi find no evidence that employers have dropped coverage, tightened eligibility for coverage, or changed the scope of benefits, network of providers or quality of care available under the health plans. Nor is their evidence that employers have shifted a greater share of the cost of health care onto their workers in response to health reform.

Recent congressional proposals and reforms advocated by the presidential candidates have renewed the debate about whether the problem of the uninsured is best addressed through subsidies to employers or to individuals. In this brief, the authors argue that it is more efficient to provide subsidies directly to individuals and families than to employers. Individual subsidies will lead to less displacement of private spending and will be more equitable. Employers have limited information about their workers, making employer subsidies more difficult to target to individuals with the greatest needs. In addition, employer subsidies do not eliminate the need for individual subsidies.