Working on the Puzzle: Health Care Coverage for Low-Wage Workers

Posted: 19 Jul 2002

See all articles by Louise G. Trubek

Louise G. Trubek

University of Wisconsin Law School


The article proposes that an "incremental" state-based/public-private approach to expanding access for health care coverage is underway. Two major shifts are encouraging this approach: the movement down of public programs through devolution to the states, and movement out toward increased reliance on private institutions to satisfy public needs. Wisconsin's BadgerCare, a program to cover working low-income families, is used as an example of how the interaction of welfare reform with workplace health coverage gaps created a state impetus towards expanded coverage. That impetus combined with the flexible use SCHIP funding has allowed states to pursue a viable strategy of expanded coverage. The move to public-private coordination has allowed states to develop private-public systems to provide the coverage. These systems employ mechanisms that not only provide coverage but also link across states through intermeshing a knowledge base and actors. The mechanisms include local collaborations, community-based delivery systems, networks, and outcomes processes. The article concludes with a discussion of three challenges to the incremental approach: linking public and private plans, meeting workplace and workforce needs. and integrating the safety net into the mainstream health care financing system.

Suggested Citation

Trubek, Louise G., Working on the Puzzle: Health Care Coverage for Low-Wage Workers. Available at SSRN:

Louise G. Trubek (Contact Author)

University of Wisconsin Law School ( email )

975 Bascom Mall
Madison, WI 53706
United States

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