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How Do We Promote Access for All Americans?

How Many Americans Are Uninsured? Who Are They?

Surveys of health insurance coverage ask questions in different ways, making it difficult to compare the results, track trends, and make comparisons among different groups. We have examined measurement and survey design issues that affect estimates of health care coverage and interpretation of data. Related publications include:

Health Policy and the Uninsured (2004). This book, edited by Mathematica senior fellow, Catherine McLaughlin, provides a comprehensive review of the literature on insurance coverage with specific attention to the methodological hurdles involved in the research; the complex interaction between health insurance and labor supply; and the special issues facing children, racial or ethnic minorities and immigrants, the near-elderly, and people with psychiatric or substance abuse disorders.

"Counting the Uninsured: A Review of the Literature" (July 1998) Pathbreaking study of methodology for counting the uninsured in the U.S.

What Strategies Work to Expand Coverage?

In recent years, many states have led the way in testing innovative ways to provide health insurance to their residents, particularly children. Our staff have compared affordability, accessibility, and quality of health insurance in many states. We are helping states build and analyze the data sets needed for planning and assessing changes to their health care insurance systems. We have also studied the Medicaid and Children’s Health Insurance Program (CHIP) to shed light on a number of pressing policy issues related to expanding coverage for children. Related publications include:

State Health Reform

"Study of Rhode Island's Uninsured: Current Costs and Future Opportunities" (March 2010). This report helps policymakers and stakeholders understand the number of uninsured in Rhode Island, current health care spending by and for the uninsured,and the change in health care spending that would occur if they became insured.
"State Policies to Encourage High-Deductible and Limited-Benefit Health Plans: Costs, Constituents, and Concerns" (March 2009). Looks at state efforts to encourage use of limited-benefit plans as a way to provide some coverage amid escalating costs.
"Improving Public Coverage for Children: Lessons from CKF in New Jersey" (August 2008). Finds that advocacy can impact insurance policy.
"Analysis of Reform Models for Extending Health Care Coverage in New Mexico" (March 2008). Analyzes different reform approaches for use in New Mexico to expand health insurance coverage.
"Leading the Way? Maine's Initial Experience in Expanding Coverage Through Dirigo Health Reforms" (November 2007). Examines progress of health care reform in Maine, one of the first states to tackle reform.
"Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families." In Brief #1 (November 2007). Notes that a new insurance product in California boosted success.
"A Compendium of State and Local Initiatives to Expand or Retain Employer-Based Coverage"
 (November 2005). Reviews major state and local programs to expand or retain employer-based coverage.
"Approaching Universal Coverage: Minnesota's Health Insurance Programs" (February 2003). Assesses one state's approach to universal coverage.


"Synthesis of 10 Case Studies: Exploring Medicaid and SCHIP Enrollment Trends and Their Links to Policy and Practice." Covering Kids & Families Evaluation (April 2009). This report gives a brief summary of the overarching findings from 10 case study reports.
"SCHIP CHildren: How Long Do They Stay and Where Do They Go?"
(January 2009) This brief highlights findings from a seven-state study examining retention of children in the State Children's Health Insurance Program (SCHIP) and coverage after they leave the program.
"Increasing Children's Coverage and Access: A Decade of SCHIP Lessons" (September 2007). Highlights states' progress in reaching more children and improving access.
"SCHIP at 10: A Synthesis of the Evidence on Substitution of SCHIP for Other Coverage"  (September 2007). Notes that the evidence suggests that substitution of SCHIP for private coverage (crowd out) does occur, with the magnitude ranging from less than 10 percent to 56 percent, depending on how substitution is defined and measured.
"Stable Coverage Benefits Healthy Kids Children" (June 2007). Looks at how a new insurance product in California benefits low-income children.
"Santa Clara County Children Health Initiative Improves Children's Health" (March 2007). Assesses efforts to cover children ineligible for major state programs.
"Congressionally Mandated Evaluation of the State Children's Health Insurance Program" (October 2005). Examines 10 state efforts to cover more children.

Are There Ways to Make Health Insurance Affordable for More Americans?

The cost of health insurance continues to rise, and many Americans need help in order to be able to afford it. Our work has examined ways to make employer-sponsored health benefits more affordable. Related publications include:

"Using Section 125 Premium-Only Plans to Expand Health Coverage" Trends in Insurance Coverage Issue Brief #5 (October 2008). Explores how states are trying to expand access to health coverage by encouraging the use of IRS rules that let employees pay their portion of the premiums for employer-sponsored health insurance on a pretax basis, which can lower their taxable income and tax liability.