State Efforts to Insure the Uninsured: An Unfinished Story

摘要

About 41 million Americans-one in seven adults-were uninsured in 2001. There is convincing evidence that being uninsured adversely affects access to health care, and an helming majority of the American public views the problem of the uninsured as a significant policy issue. Over the past decade, the states have been the laboratories for trying new approaches to insuring the uninsured. These include regulatory reform, adopting purchasing alliances, expanding public programs, providing new public subsidies, and shoring up the safety net-the configuration of public hospitals and clinics that provide health care to those without insurance. Reforms in the market for small-group insurance and small- group purchasing alliances are intended to make insurance more accessible and affordable for small businesses, which are less likely to offer insurance to their workers than are larger firms. Expanding the availability of group insurance targets the 40 percent of the uninsured who work in small businesses and their depen- dents. Expanding public programs and new public subsidies are intended to make insurance more readily available and affordable to low-income uninsured persons, regardless of their work status. A series of studies conducted by RAND economists Susan Marquls and Stephen Long have examined how successfiil these state experiments have been. Overall, the results show that states have not yet solved the problem of the uninsured. But the experiments have provided important lessons for policymakers that may help to shape the next wave of programs.