Research by Author & Topic

Publications by Linda J. Blumberg on Medicaid

Emotions are flaring as constituents speak their minds to members of Congress home for August recess. That's to be expected, since health care is both a personal and public issue, but let's not forget to debate the basics:

Because a small fraction of individuals account for a large share of total health expenditures, insurers gain more by excluding high-cost people from coverage than by efficiently managing the care of enrollees. The incentives for insurers to avoid high-cost and high-risk enrollees affect not only the likelihood of health insurance coverage for the high-risk population, but also the cost and accessibility of coverage overall in the small-group and nongroup private health insurance markets. This paper identifies public policies that might address these problems in private health insurance markets more effectively and delineates the advantages and disadvantages of each.

In this paper and brief, the authors discuss alternative ways that health reform could be financed. They analyze different options including several proposals for delivery system reforms and for reduction in Medicare and Medicaid payments. They estimate the cost savings that could occur due to the introduction of a public plan option. Finally, they explore a range of revenue options. The key message of the paper is that health reform can be paid for, but it is best to obtain funds from a large number of measures to spread the burden broadly.

The Bush Administration has proposed using a tax deduction approach to expand health insurance coverage instead of expanding SCHIP coverage for more children. On October 3, the president vetoed the SCHIP reauthorization bill passed by Congress. This brief compares the financial burden for families associated with purchasing coverage for their children under the President's proposal and under the SCHIP reauthorization bill and discusses the likely impacts on uninsurance among children. We find that the financial burdens for families between 150 and 300 percent of the federal poverty level would be much higher under the tax deduction approach than under SCHIP.

As the number of uninsured grows, and the share with employer-sponsored insurance (ESI) falls, questions arise about the future viability of our largely employer-based insurance system. Significant weaknesses exist in the system, and these are heightened for the low-income working population and their employers. A menu of policy options are available for expanding coverage, and expansions will require a combination: income and health status related subsidies; a guaranteed source for all individuals to obtain coverage; requiring at least a minimum level of insurance; requiring employers contributions; increasing enrollment and retention in existing insurance options; and cost containment strategies.

An important challenge in designing policy initiatives to address the problem of uninsured children is that the objectives implicit in the programs can conflict. These conflicts necessitate prioritizing multiple objectives and identifying acceptable tradeoffs in order to achieve effective policy design that reflects the nation's social priorities. This article provides a general discussion of some competing objectives and tradeoffs and presents a framework for evaluating future attempts to design children's health insurance programs. (The Future of Children 13(1): 205–11, Spring 2003.)