Incremental strategies for providing health insurance for the uninsured. Projected federal costs and number of newly insured
K. E. Thorpe
Department of Health Systems Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, La 70112, USA. kthorpe@mailhost.tcs.tulane.edu
OBJECTIVE: To present several incremental strategies for extending health
insurance coverage for segments of an estimated 40.6 million uninsured
persons in the United States. Along with these strategies, the federal
costs and estimates of the number of newly insured are presented. DESIGN:
Using data from the Congressional Budget Office and the federal government,
the number of newly insured persons in the United States under options
designed to increase coverage among uninsured children, their parents, and
workers between jobs are simulated. The federal costs and coverage
implications of these options are estimated for federal fiscal years 1998
through 2002. METHODS: Three distinct incremental approaches for covering
the uninsured are explored. The first approach would expand coverage
through the current Medicaid program. The second approach would provide
financial incentives for parents of children eligible for Medicaid to
purchase coverage, and the final approach provides time-limited subsidies
allowing workers and their families to purchase insurance when they are
between jobs. MAIN RESULTS: The federal costs of these approaches range
from $2 billion to $3 billion per year (enrollment outreach approach) to $5
billion to $7 billion per year (enrolling parents of Medicaid-eligible
children approach). If pursued simultaneously, the incremental strategies
under investigation could extend health insurance to more than 7 million
uninsured persons in the United States. The cost of these options could be
financed through Medicaid savings, restructuring the current
disproportionate share payments made through Medicare and Medicaid,
increasing excise taxes on tobacco, or all of the above. CONCLUSIONS: The
incremental strategies would build on the current US health care delivery
system by providing targeted financial assistance to specific populations.
By their nature, such reforms could provide a political means for
compromise and agreement between Congress and the president. Though the
reforms do not, by design, provide a comprehensive solution to the problems
facing the uninsured, they would address the severe problems facing many
low- and middle-income families unable to purchase health insurance today.
