Impact of Program Eligibility Criteria on Recipient Access and Continuity ofCare: Experience of the MaineCare and Washington Basic Health Plans. Abstract, Executive Summary and Final Report of Dissertation

摘要

The study compares a subsidized small business health insurance initiative and anincome-eligibility family coverage initiative with regard to their impact on the scope of medical indigence in their respective states. Participant survey information is used to develop enrollment profiles for each program. Multinomial logic models identify enrollee characteristics predictive or recidivism to uninsured status and link disenrollment dynamics to program eligibility criteria. The study found that program eligibility criteria strongly influenced both enrollment and involuntary disenrollment. The individual income-based plan reached a far more heterogeneous uninsured population and had higher rates of enrollment than the small employer-based plan. Rates of involuntary disenrollment were proportionately much higher in small business initiative and resulted in a return to uninsured status among approximately half of disenrollees (compared to 19 percent in the individual plan). Job change and family labor force characteristics were the factors determinative of enrollment disposition in both programs. The enrollment success of the income-based program helped build political momentum in the host state for passage of a comprehensive reform measure. The small business initiative failed to generate support among business interest groups of broader government intervention in health policy.