NCPA - National Center for Policy Analysis

States Learn from Efforts to Insure the Uninsured

January 12, 2004

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 public hospitals and clinics that provide health care to those without insurance.

A series of studies by RAND economists Susan Marquis and Stephen Long have examined how successful these states experiments have been. Overall, the results show that states have not been able to reduce their uninsured populations, even by expanding Medicaid and the State Children's Health Insurance Program:

  • Neither regulatory reform nor health insurance alliances have increased the percentage of small businesses offering health insurance to their employees, nor did they reduce small-group market health insurance premiums.
  • Subsidizing public insurance expands coverage, but large reductions in the uninsured would require large subsidies; even with a modest premium of $10 per month, about one-third of adults and nearly 10 percent of children would remain uninsured.
  • Expanding public insurance causes some individuals to replace private insurance with public coverage, increasing the costs of public programs; approximately 50 percent of new participants in the public program substituted public insurance for private insurance.

Expanding the safety net might be more effective in improving the health of some disadvantaged populations than providing insurance -- Marquis and Long found that where low-income women received care affected birth outcomes more than whether or not they had insurance.

Source: "State Efforts to Insure the Uninsured: An Unfinished Story," RAND Health, Research Highlights 2003, RAND Corporation.

For RAND text


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