As publicly funded health insurance programs shift more toward coverage of working families in low and moderate incomes, there has been a growing interest in beneficiary cost sharing in the form of sliding-scale premiums. In this study we examined four publicly-sponsored health insurance programs aimed at working-class families--Hawaii’s QUEST, Minnesota’s MNCare, Tennessee’s TennCare, and Washington’s BHP. The experience in these states indicates that it is feasible to require cost sharing of premiums, but there are a number of design and operational complexities. A preliminary analysis indicates that higher out-of-pocket premium shares were associated with lower participation rates.(Inquiry Winter 1999/2000; 36(4):471-480).
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