Citation URL: http://www.urban.org/LisaClemans-Cope

The ability of employed parents to meet the health needs of their children may depend on their access to sick leave, especially for low-income workers. By examining access to paid sick leave and paid vacation using the 2003-2004 Medical Expenditure Panel Survey, the authors find that low-income families are less likely to have access to paid leave, especially if the family lacks a full-time/full-year worker. Among children whose parents have access to paid sick leave, parents are more likely to take time away from work to care for themselves or others.

The Reinsurance Institute provided quantitative modeling and qualitative analysis to states as they explored reinsurance as an element of health reform. The project estimated the impacts of reinsurance, including changes in premiums, employer offer and enrollee take-up of coverage, numbers of people insured, and costs to the state. Small numbers of high spenders account for a large share of health spending, but most spending occurs in lower corridors of expense. Medical spending varies widely by age and health status, creating pressure for risk segmentation. Lastly, defining the eligible population determined whether reinsurance would cover new enrollees or solidify current coverage.

The Reinsurance Institute simulated the effects of reinsurance on individual and employer behavior, observing state-specific characteristics. We constructed a baseline database for each state by reweighting and combining multiple data sources to create a profile of individual-level demographics and health expenditures, allowing for the computation of individual-level premiums. We grouped health insurance units together into risk pools consistent with state market rules to calculate the change a reinsurance subsidy would have on the premium levels faced by individuals and employers. These price changes drove simulated changes in premium and coverage levels, offer and take-up rates, and state costs.

In April, the House of Representatives passed a bill to prevent individuals with Health Savings Accounts from easily, but illegally, evading taxes. The loudest response has been opposition from the insurance industry and its political allies.

This report estimates the benefits and costs of alternative forms of state-funded medical reinsurance in Washington using the Urban Institute's Reinsurance Model. A subsidy targeted at all small firms would substantially increase primary coverage but would be very expensive, as most benefit would flow to already insured people. Targeting the conventional small group market by excluding association health plans would reduce state cost per newly uninsured person and would bolster existing regulatory requirements for that sector;s insurers to use modified community rating. Any practical program also needs to identify secure funding and maintain cost consciousness among newly reinsured health plans.

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.

This issue brief focuses on how employer-sponsored insurance (ESI) coverage has changed among employees. It begins with a brief description of major forces driving ESI: changes in the workforce and the rising costs of health insurance over the four year period. Next, it examines the decline in ESI among employees and the underlying reasons determining whether an employee has ESI, specifically: employer sponsorship of ESI, employee eligibility, employee participation, and employee participation in ESI available through another family member's job. The issue brief concludes by examining how the reasons for the decline in ESI varied across different groups of employees.

Lack of health insurance can affect the health and productivity of workers as well as the health of workers’ families, especially for low-income families, who are more likely to have members in poor health. We show that about half of children in low-income families do not have access to employer-sponsored insurance (ESI). Among the families without access to ESI, public insurance fills some gaps among children, but parents remain uninsured at high rates. For these families, children are twice as likely—and parents are nearly three times as likely—to be uninsured compared to families with an ESI offer.

This study lays out both advantages and disadvantages of the use of high deductible plans (HDHPs) with Health Savings Accounts (HSA). It touches on why this solution may exacerbate risk selection issues that already seem to be present in Missouri. It also discusses how these plans can be a somewhat better deal for a large swath of the population that is younger and healthier but only at some cost.

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.

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