Citation URL: http://www.urban.org/AlanWeil

This paper presents several options designed to help the Commonwealth of Massachusetts move to universal health insurance coverage. The alternatives all build upon a common base that includes an expansion of the Medicaid program, income-related tax credits, a purchasing pool, and government-sponsored reinsurance. These measures in themselves would not yield universal coverage, nor would an employer mandate by itself. We show that an individual mandate, and an employer mandate combined with an individual mandate, both would yield universal coverage with a relatively small increase in government costs relative to state gross domestic product and current health spending.

Most of the steps necessary to implement the tax credit provisions of the Roadmap build from a foundation within the current administration of MassHealth and the existing tax code. The most significant challenge would be to encourage eligible families to apply for and receive the tax credit during the year rather than at the end. This would require extensive outreach and education and a simple application process fully integrated with the purchasing pool. The existence of an individual mandate would certainly encourage more people to apply for the tax credit. (www.roadmaptocoverage.com, October 7, 2005)

This report synthesizes all of the research and analytic work done on the Roadmap initiative, describes three policy approaches that would achieve universal health coverage in the Commonwealth, and describes the issues that would need to be addressed in order to implement the Roadmap options. The report describes each of the building blocks in turn, followed by the mandate alternatives. The cost and coverage estimates were produced using the Health Insurance Reform Simulation Model, developed by Urban Institute researchers. The report also discusses options for financing the coverage expansions, the likely benefits from universal coverage, and the broader economic impacts.

This paper describes the steps necessary to implement the Roadmap proposals. It sets forth a realistic schedule for completing the tasks necessary for successful implementation. It also discusses significant policy decisions that would need to be made along the way--decisions that would take the Roadmap from its broad policy outline to the specifics of public policy on the ground. Implementing and enforcing an individual mandate must be done with care. Whether based on an individual mandate alone, or combined individual and employer mandates, a system of truly universal coverage is at least four years away. (www.roadmaptocoverage.com, October 7, 2005)

This report presents several options designed to help Massachusetts move to universal health insurance coverage. Each strategy is outlined in the form of a policy proposal and includes analysis of the effects on cost and coverage. The policies all build on an expansion of MassHealth, income-related tax credits, a purchasing pool and government-sponsored reinsurance. These measures in themselves do not yield universal coverage, nor would an employer mandate. The building blocks and an employer mandate combined with an individual mandate would yield universal coverage with a relatively small increase in government costs relative to state GDP and current health spending. (www.roadmaptocoverage.com, June 21, 2005)

This is the testimony of Assessing the New Federalism Director Alan Weil before a House Budget Committee hearing on Department of Health and Human Services (HHS) budget priorities for fiscal year 2005. Mr. Weil focuses on how the HHS budget will affect Americans' health insurance coverage, finding that the few proposals it makes in this area offer benefits to the healthy and wealthy at the expense of the sick and the poor, threaten to undermine the base of employer-sponsored health insurance that covers the majority of Americans, and endanger public coverage through Medicaid.

In a letter to the Los Angeles Times, Alan Weil, director of the Urban Institute's Assessing the New Federalism project, takes issue with HHS Secretary Tommy Thompson's response to the recent Institute of Medicine report calling for health insurance coverage for all Americans by 2010.

This is the testimony of Assessing the New Federalism Director Alan Weil before the District of Columbia Department of Health regarding the Healthy People 2010 Draft Biannual Implementation Plan (2003-2004) for the District of Columbia. Mr. Weil addresses two goals of the plan: a comprehensive data reporting system as an update to the aging Medicaid Management Information System and access to comprehensive behavioral health services for all Medicaid-eligible persons.

This analysis of seven states (California, Colorado, Florida, Michigan, Mississippi, New Jersey, and Washington) shows that the severity of the current revenue crisis far exceeds that of the recession that triggered it because states cut taxes and expanded programs based on unsustainable revenue growth during the late 1990s. All of the states studied responded to revenue declines with short-term solutions -- using reserves, transferring other funds to the general fund, refinancing debt, and shifting expenditures or revenues across fiscal years. All but New Jersey and Washington cut spending. Only New Jersey relied heavily on tax increases. The authors suggest that states should be realistic about the sustainability of future revenue trends and should not count on federal help. States should also build up reserves and be able to draw on them when needed, and should make tax policies symmetrical rather than place special barriers against tax increases.

The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children’s Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.

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