Alliance for Health Reform Meeting Discusses State and Local Efforts to Cover the Uninsured

Some of the most "creative" efforts to cover the uninsured have been developing at the state and local level, Ed Howard, executive vice president of the Alliance for Health Reform, suggested at a Nov. 21 conference hosted by the group. The meeting, entitled "Closing the Gap: State and Local Efforts to Cover the Uninsured," addressed nationwide efforts to reduce the number of uninsured, focusing on programs in New York City and Hillsborough County, Fla. Vickie Gates, vice president of the Academy for Health Services Research and Health Policy, first spoke on the basic approaches most states have taken to increase coverage, including the expansion of Medicaid -- the most common method by which states have been attempting to cover the uninsured. Many states have taken advantage of the Medicaid Section 1115 waiver authorized by the Social Security Act, which allows states more flexibility to extend the Medicaid program to populations that normally would not qualify for coverage. For example, Wisconsin and Minnesota have used the waiver to develop family coverage programs, while Delaware and Oregon have implemented waiver expansions to cover all non-elderly below 100% of the federal poverty level. Moreover, Tennessee's TennCare program currently covers those who are unable to obtain health insurance because of chronic health conditions. The joint federal-state Children's Health Insurance Program has been another popular vehicle for expanding coverage, a program that Gates believes has fostered "more innovative thinking" at the state level (Meredith Weiner, Kaiser Daily Health Policy Report, 11/22). Thirty-seven states now provide coverage through CHIP for children of families with up to at least 200% of the federal poverty level, while five of these states (Connecticut, Maryland, Missouri, New Hampshire and Vermont) have increased coverage for children up to 300%, and New Jersey has increased its CHIP eligibility to 350% of the poverty line (Alliance for Health Reform brief, 11/00). Employer-Based Programs The conference also focused on independent state and community programs that go beyond the limits of Medicaid and CHIP to reach those who miss out on public programs and employer-sponsored coverage. Rima Cohen, vice president of the Greater New York Hospital Association, spoke about two programs currently being developed under the state's Health Care Reform Act of 2000: "Family Health Plus" and "Healthy New York." Both programs will receive partial funding from the state's tobacco settlement and 55 cent-per-pack cigarette tax increase. The programs jointly target populations that traditionally have been difficult to cover: poor adults who have no dependent children, adults whose children qualify for Medicaid or CHIP, and those who work for small companies that have large numbers of low-income workers. Gates estimates that together, these two programs will cover up to 1 million New Yorkers, or about one-third of New York's current 3.1 million uninsured. Community Programs Patricia Bean, Deputy County Administrator in Hillsborough County, Fla., presented a briefing on the county's unique program implemented in 1992 to cover county residents with incomes below 100% of the federal poverty level. The program also covers those with chronic diseases or catastrophic medical problems. The Tampa, Fla.-area county contracted with local provider networks and established funding for the program through a half-cent local sales tax earmarked for the program (Meredith Weiner, Kaiser Health Policy Report, 11/22). Program participants are not required to pay a premium or any other costs. The county has achieved an 85% program participation rate among Hillsborough's 30,000 uninsured. The Alliance for Health Care Reform concludes that if "replicated widely and financed securely," these independent state and community programs "could help close the health insurance gap in America" (Alliance for Health Care Reform brief, 11/00).