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Lessons From State Reform Efforts

Kathleen Thiede Call, PhD; Nicole Lurie, MD, MSPH; Yvonne Jonk; Roger Feldman, PhD; Michael D. Finch, PhD

JAMA. 1997;278(14):1191-1195.

Abstract
Objective.
—To describe Minnesota's health care system reform efforts and their implications for other state and national reform initiatives, document the rate of uninsurance in 1990 and 1995 with special attention to childrens' access to health insurance, and examine the effectiveness of Minnesota Care, a voluntary statesubsidized health care plan, in serving its target population.

Design.
—Three cross-sectional telephone surveys: 2-stage random samples of Minnesotans of all ages in 1990 and 1995 and a stratified random sample of Minnesota Care enrollees in 1994.

Participants.
—For the 2 statewide surveys, 10310 respondents participated in 1990 and 11 519 in 1995; more detailed information was collected on approximately 1600 respondents in each survey. Eight hundred Minnesota Care enrollees participated in the third survey conducted in 1994.

Main Outcome Measure.
—Changes in rates of uninsurance.

Results.
—While the rate of uninsurance increased at the national level, the point-in-time Minnesota rate remained stable and low at 6% between 1990 and 1995. The proportion of children uninsured for 12 months or more decreased from 5.2% in 1990 to 3.1% in 1995, while the proportion of uninsured single adults remained stable at approximately 11%. There was no evidence that Minnesota Care enrollees are gaming the program, or that the program has resulted in significant erosion from the private market.

Conclusions.
—Minnesota Care has enabled the state to maintain a low rate of uninsurance and has reduced this rate among its primary target: children. The program has been less effective in enrolling single adults, although it may be too early to witness the effects of recent expansions targeting this group. Minnesota's experience suggests that other state and national reform efforts aimed at reducing uninsurance, particularly among children, are likely to be successful.

Author Affiliations
From the Institute for Health Services Research, School of Public Health (Drs Call, Lurie, Feldman, Finch, and Ms Jonk), and the Division of General Internal Medicine, School of Medicine (Dr Lurie), University of Minnesota, Minneapolis; and Hennepin County Medical Center, Minneapolis, Minn (Dr Lurie).

Footnotes
The views expressed are those of the authors and do not necessarily reflect the position of the University of Minnesota or the funding agencies.

Corresponding author: Kathleen Thiede Call, PhD, Institute for Health Services Research, School of Public Health, University of Minnesota, Box 729 Mayo, 420 Delaware St SE, Minneapolis, MN 55455 (e-mail: callx001@gold.tc.umn.edu).

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