Abstract

http://ssrn.com/abstract=191529
 


 



Three Political Realities in Expanding Coverage for the Working Poor: One State's Experience


Eleanor D. Kinney


Indiana University Robert H. McKinney School of Law

Ming Tai-Seale


Texas A&M University - Department of Health Policy & Management

James Y. Greene


Human Dimensions of Health Care, Inc.

Rilla Murray


Indiana State Department of Health

William Tierney


Indiana University Purdue University Indianapolis (IUPUI) - School of Medicine; Kansas State University


Health Affairs, P. 188, July-August 1999

Abstract:     
In recent years, states have experimented with innovative approaches to expand coverage for underserved persons. Yet lack of health insurance among low income workers remains a problem. A 1997 survey reported that more than half of adults in low income, working families have been uninsured sometime in the previous two years. This group is likely to increase in the future as states implement time-limited welfare benefits and if employer-sponsored health coverage continues to decrease as in recent years.

This paper describes the bipartisan effort of the Indiana Commission on Health Care for the Working Poor to design coverage expansions for uninsured, low income workers and families in Indiana. Initially, legislators challenged the state's insurance industry to develop a private health insurance plan that the state might subsidize to make it affordable to low income workers and/or their employers. However, based on findings from Indiana focus groups of working poor that the Commission conducted, the Commission recommended strategies to mobilize existing safety net providers into networks to provide comprehensive and coordinated care to low income workers and families in designated service areas. Specifically, the state would pay direct subsidies for primary and preventive care to community health centers that participate in networks with safety net hospitals. Also, the state would establish a state-sponsored stop loss fund to protect network hospitals against expenses incurred in the care of catastrophically ill network clients.

These strategies reflect three realities that face states as they craft health coverage expansions for uninsured low income workers and families in today's health policy environment. First, in a conservative state, policy makers are unwilling to pay the cost of even limited coverage for low income workers and families. Second, the uninsured poor already obtain care from safety net providers that are programmatically constituted and ideologically committed to serve them. Third, this lack of demand for health coverage with minimum benefits threatens voluntary participation in a subsidized private program. The findings of the focus groups confirmed that, unless heavily subsidized, it is unlikely that low income workers are going to purchase even heavily subsidized health insurance to finance their health care.

Given the constraints of the day, addressing the need for health coverage for the remaining uninsured calls for innovative thinking beyond conventional paradigms. Direct subsidies for community health centers and subsidized stop loss protection for safety net hospitals to facilitate the development of networks are promising strategies for extending coverage to uninsured, low income workers and families. While not a substitute for enrollment in a fully-paid health plan, these strategies do promise real improvement in access to high quality health care services for this group of vulnerable Americans.

Accepted Paper Series





Not Available For Download

Date posted: December 6, 1999  

Suggested Citation

Kinney, Eleanor D. and Tai-Seale, Ming and Greene, James Y. and Murray, Rilla and Tierney, William, Three Political Realities in Expanding Coverage for the Working Poor: One State's Experience. Health Affairs, P. 188, July-August 1999. Available at SSRN: http://ssrn.com/abstract=191529

Contact Information

Eleanor D. Kinney (Contact Author)
Indiana University Robert H. McKinney School of Law ( email )
530 West New York Street
Indianapolis, IN 46202
United States
2741912 (Phone)
HOME PAGE: http://indylaw.indiana.edu/people/profile.cfm?Id=17

Ming Tai-Seale
Texas A&M University (TAMU) - Department of Health Policy & Management ( email )
TX
United States
James Y. Greene
Human Dimensions of Health Care, Inc. ( email )
P. O. Box 35
Creston, NC 28615
United States
Rilla Murray
Indiana State Department of Health ( email )
2 North Meridian St.
Indianapolis, IN 46204
317-233-7754 (Phone)
William Tierney
Indiana University Purdue University Indianapolis (IUPUI) - School of Medicine ( email )
Indianapolis, IN
United States
Kansas State University
Manhattan, KS 66506
United States
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