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Health
Insurance
Overview
Whether an individual has health insurance or not is
an important factor in a person’s health status
and access to quality health care. Numerous programs
are available to help decrease the number of uninsured
and underinsured people in the United States. These
programs include Medicare,
Medicaid,
SCHIP,
and tax incentives for managed care organizations and
businesses. In addition, numerous programs have popped
up to serve individuals who still do not have access
to affordable health care as a result of no health insurance.
RC/EZ/ECs can play a role in helping eligible persons
in their communities enroll in available insurance programs,
assisting businesses in offering affordable and quality
insurance programs, and partnering with health centers
who serve uninsured clients. For example, HRSA’s
Bureau of Primary Health Care supports 746 community
and migrant health centers, 128 health care programs
for the homeless, and 22 primary care programs for public
housing projects that provide low and no cost services.
There are also numerous public and private research
initiatives underway to look at policy and health care
reform, which RC/EZ/ECs can consider in their policy
efforts. For example, the Kaiser
Commission on Medicaid and the Uninsured analyzes
health care coverage and access for low-income populations
and looks at possible areas of reform.
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Stories
and Models from the field
Community Develops Their Own Solution for Affordable
Health Coverage
Muskegon, Michigan, EC (Round I)
Community leaders in Muskegon County recognized the
problem of rising numbers of uninsured residents and
tried to address it through traditional health insurance.
After unsuccessful efforts to purchase group insurance
for the uninsured, community leaders decided to take
action rather than wait for a solution to appear.
Beginning in 1995, the Muskegon Community Health Project
(MCHP) engaged business leaders, health care providers
and community groups in the process of developing a
solution, which involved planning meetings and surveys
to determine what approach would work best for the community.
They came up with two solutions–Access Care, a
health coverage plan for working people and Muskegon
Care for indigent persons. Residents may move between
these two programs, and eventually on to private insurance
as their economic situation improves.
Muskegon County is now providing affordable health
coverage to working uninsured through their employers
with an innovative cost sharing program between employer,
employee and community (including federal disproportionate
share hospital funds, local government, community and
foundation funds). The Access Health plan pays 40% of
the cost, while the employer and employees each pay
30%. The program is geared toward workers who make $6
-$10 an hour. "These are not people the market makes
money on," says Vondie Moore Woodbury, director of the
project. "But we have 17,000 people here who are uninsured."
Rather than waiting for a solution, we decided we would
do it ourselves.
Currently, the Access Health plan covers almost 1,000
formerly uninsured residents, and Muskegon Care covers
2,000 formerly uninsured residents. A team of outreach
workers inform businesses about the plan and sign up
interested business. If a business is not interested
in participating, MCHP requests permission to send a
representative on site to inform employees about Muskegon
Care and other possible options, including the SCHIP
and Medicaid programs for families with children. The
MCHP storefront located in the EZ also serves as a resource
center for community members to learn about all of these
health coverage options.
The Muskegon Community Health Project is headquartered
in the Muskegon EC, and has worked closely with EC community
leaders. Many of the EC residents are now participating
in these programs. Several important lessons were learned
in implementing this solution, including:
- Planners need to realize that "one size does not
fit all", and must be flexible in understanding the
target demographic group and conducting research to
understand how to market the product.
- Solutions that work require creative thinking. An
example of this can be found in the redeployment of
DSH funds that Federal law provides to hospitals serving
a "disproportionate share" of Medicaid or low-income
patients to pay for a whole range of health services
instead of being used only to support indigent hospital
care.
- Community involvement is critical to the success
of a new program. Many of the creative approaches
taken in structuring the program were acceptable to
the community because they were ideas that originated
in the community, and the product was community-owned.
Access Health continues to use their community board,
with representation from patient, provider, and community.
For more information, visit Access
Health on the web.
Small Business Subsidies and Community Outreach
Insure More Residents
Denver, Colorado EC
The Denver Health Community Voices, located in the
Denver EC has developed ways to make insurance more
affordable to its residents through small business health
insurance subsidies and community outreach to increase
government insurance enrollment.
Denver Health's small business premium subsidy program
enables eligible small businesses to offer coverage
to employees. The subsidy is worth 20-50% of the premium
for both the employer and employee, and is determined
on a sliding scale. Currently, 21 small businesses are
enrolled in the program and receiving a subsidy. These
21 businesses include 66 subscribers and 108 members.
The community outreach effort is designed to improve
the enrollments of eligible individuals into government
health insurance programs. Trained health workers from
the community assist residents with enrollment applications
at libraries, schools, homeless shelters, churches and
community gatherings. In 2000, 71,000 applications were
taken from previously uninsured people in Denver. As
a result, approximately 46,000 individuals received
coverage in publicly funded insurance programs.
Student Volunteers Help Enroll Children in Government
Insurance Programs
Upper Manhattan, New York EZ (Round I)
Students from Columbia University participated in an
Upper Manhattan pilot test of the Student Health OUTreach
project (SHOUT) sponsored by the Children's Defense
Fund. The project aims to enroll currently uninsured
children in government insurance programs for which
they are eligible. In many cases families do not know
that the children are eligible for the free and low-cost
coverage. Students were fully trained in the insurance
programs eligibility requirements and cultural sensitivity.
The Alianza Dominicana Community Center, located in
the Upper Manhattan EZ hosted a number of the SHOUT
volunteers in their recruitment efforts. The Center
distributed literature about Medicaid, Child Health
Plus and the SHOUT project to their clients and contacts
as well as provided the space for students to meet with
families, and access to business facilities.
Community Fund Reimburses Health Care Providers
for Servicing the Working Uninsured
OH - Ironton/Huntington,WV (EZ Round II)
Offering the Uninsured of Cabell
County Healthcare is the goal of the program
commonly referred to as OUCH! Through this program providers
serving the working-uninsured are reimbursed by a community
fund. The fund was created with money from three sources:
the employee who is uninsured (30%), the employer (30%),
and program and community funds (40%). This program
aims to share the cost of uncompensated care in Cabell
County by addressing the uncompensated care issue up
front. In doing so, the burden isn't placed back on
the community through taxes; and, by having a larger
group to support the costs, no one entity or group is
overwhelmed with costs. The fund reimburses health providers
for services rendered to participants of the OUCH! Program.
Patients who were previously faced with self-pay, full-responsibility
health service costs now have their own costs covered
by the OUCH pool. Providers, who were previously not
being paid for services rendered, receive reimbursement
from the OUCH! pool. Businesses who were forced to help
pay the burden of uncompensated care now have a decreased
burden as a result of the OUCH! Pool.
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Tools
Start
Healthy, Stay Healthy Outreach Handbook
A comprehensive guide to creative outreach strategies
filled with real-life examples from states and communities
where outreach activities are working. It also has fact
sheets on Medicaid, welfare program changes, new funds
for child health insurance, managed care, and other
important information.
Student
Health Outreach Project (SHOUT) Toolkit
The Student Health Outreach Project, SHOUT, is a student-run
project of the Children's Defense Fund that strives
to ensure all of our nation's children have access to
health care. Of the 11 million uninsured children in
this country, more than 6 million of them are eligible
for free health insurance through Medicaid and the State
Children's Health Insurance Program (SCHIP). SCHIP is
a $48 billion investment in children's health coverage
that reaches out to millions of uninsured children whose
family incomes are too high to qualify for Medicaid
but too low to afford private insurance. However, children
will not receive health coverage through these programs
automatically. Their parents must apply for it. The
problem is that many parents do not know SCHIP exists
or that their children might be eligible. The SHOUT
program trains college students in how to identify and
enroll eligible children in communities with the most
need.
Tax
Incentive Guide for Businesses in the Renewal Communities,
Empowerment Zones and Enterprise Communities
This guide contains information for eligible businesses
on the tax incentives available to them, including incentives
for offering health insurance to their employees. The
two tables listed below summarize the tax incentives.
- Tax Incentive Matrix for Urban and Rural EZs/ECs/RCs
(Page 4)
- Summary of Tax Incentives: Tax Credits, Deductions,
Bonds and Capital Gains (Pages 5-9)
Strategies for Broadening Insurance Coverage
While not all of these strategies apply at the community
level, there are some useful strategies listed below
for helping to increase insurance coverage.
The following policy recommendations, as part of a
comprehensive reform strategy, are geared to broaden
access to insurance coverage:
- Expand employment-based coverage by requiring employers
to offer coverage or contribute to insurance pools;
though controversial and subject to some adverse side
effects, this reform is the most effective way to
expand coverage within the private, employment-based
insurance system. It requires:
- Establishing purchasing co-operatives for small
firms or "buy-ins" to existing group plans such
as Federal Employee Health Benefit Program or
state employee health plans;
- Providing subsidies or tax credits to vulnerable
employers; and
- Providing direct subsidies or refundable tax
credits to low-income workers to help them afford
their share of employer-sponsored coverage, and
to low-income people purchasing COBRA coverage.
- Political realities may require a serious effort
to provide strong incentives to employers to offer
coverage, and individuals to obtain insurance, before
enacting the above requirement. In addition to purchasing
co-operatives and "buy-ins," this includes:
- Providing substantial subsidies or tax credits
to employers who newly offer coverage to employees;
- Providing significant tax credits to purchase
individual coverage for those remaining without
access to employer-based coverage; and
- Establishing state rate bands in the individual
and small-group insurance markets to reduce the
disparity in health insurance premiums related
to risk factors.
- Increase enrollment of eligible populations into
government-funded insurance programs. This can be
accomplished through:
- Conducting outreach through public awareness
campaigns;
- "Out-stationing" eligibility workers in a variety
of community sites such as health clinics, child-care
centers, schools, religious institutions, and
social service agencies;
- Holding eligibility workers accountable for
erroneously denying benefits, and providing incentives
to promote appropriate enrollments;
- Simplifying the application process and providing
information and application forms in multiple
languages;
- Computerizing the application submission and
response process to reduce human bias and error,
and speed turnaround; and
- Instituting 12-month continuous Medicaid eligibility,
"presumptive" eligibility, and single insurance
cards that do not denote source of payment.
- Expand government-funded programs and develop new
insurance products. This could include:
- Expanding eligibility for existing government-funded
insurance programs such as Medicaid, Medicare
and SCHIP (e.g., extending SCHIP eligibility to
parents, and allowing people with incomes above
current cutoffs to "buy-in" to Medicaid or SCHIP
on a sliding scale basis; instituting a buy-in
to Medicare for early retirees); and
- Developing new insurance products tailored to
the needs of vulnerable, low-income people who
remain disenfranchised from other sources of coverage.
Strategies for Broadening Insurance Coverage, from
Increasing Access: Building Working Solutions
(J. Meyer and S. Silow-Carrol, ESRI, funded by Community
Voices project).
Insure
Kids Now!
Insure Kids Now! is a national campaign aimed at linking
uninsured children to free or low cost health insurance.
Click
here for outreach tools, policy resources, and the
Insure Kids Now! toolkit and promotional resources.
SCHIP
Outreach Information Clearinghouse
This site offers community-based outreach information
such as strategies that work, reports from outreach
conferences sponsored by CMS, official SCHIP guidance
and tools, and CMS outreach contacts.
Community-Based
Organizations: Paving the Way to Children's Health Insurance
Coverage
Here you can download (in PDF format) a guide to aid
public and private organizations embark on a children's
health insurance outreach campaign.
Kids
Count Network Resource Library
Search the Kids Count Network resource library for
state-based KIDS COUNT projects including tools and
publications that can assist your RC/EZ/EC improve the
well being of children in your community.
Enter keywords: "health insurance".
 | These technical assistance resources for RC/EZ/ECs were
funded by the Office of the Assistant Secretary for Planning and Evaluation,
U.S. Department of Health and Human Services (HHS), through a cooperative
agreement administered by the Health Resources and Services Administration
(HRSA), and prepared by the Public Health Foundation. Duplication
and adaptation, with credit, are encouraged. |  |
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Tips
for RC/EZ/ECs
- Work on strategies to help subsidize employer's
purchase of health insurance for employees.
- Consider contracting a technical assistance person
to assist businesses in health insurance purchasing
decisions.
- Encourage businesses to take advantage of the Welfare
to Work Tax Credit by hiring long-term family assistance
recipients.
- Work with local public health agencies to increase
State Children's Health Insurance Program enrollment.
- Petition policy makers at the state level to expand
Medicaid eligibility through HCFA approved waivers.
- Be aware of research initiatives to use for policy
efforts.
- Split the pool of money among who you're insuring.
Collect some contribution for those who are working
and can afford a modest contribution. This will help
your resources go further.
- Lobby legislators to establish tax incentives for
health maintenance organizations managed care organizations
that locate in an RC/EZ/EC.
- Keep in mind that comprehensive insurance will
not happen over night.
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Links
Centers for Medicare
and Medicaid Services
The Centers for Medicare and Medicaid Services (formerly
the Health Care Financing Administration), administers
the Medicare and Medicaid programs, which provide health
care to America's aged and indigent populations, about
one in every four Americans, including nearly 18 million
children and nursing home coverage for low-income elderly.
CMS also administers the State Children's Health Insurance
Program through approved state plans that cover more
than 2.2 million children. Browse this site for information
on these government health insurance programs.
Community
Voices
Community Voices: HealthCare for the Underserved, a
multi-year initiative funded by the W.K. Kellogg Foundation,
is designed to improve access to quality health services.
Building up from the community level, the project is
giving the underserved-the working poor, individuals
or families who receive public assistance and those
who lack any or adequate health insurance-a voice to
help make health access and quality part of the national
debate. This site contains a wealth of information about
what 13 communities are doing to address the issue of
inadequate access to health care.
Commonwealth Fund
The Commonwealth Fund is a private foundation that supports
independent research on health and social issues and
makes grants to improve health care practice and policy.
The Fund is dedicated to helping people become more
informed about their health care, and improving care
for vulnerable populations such as children, elderly
people, low-income families, minority Americans, and
the uninsured. The Fund's two national program areas
are: improving health insurance coverage and access
to care and improving the quality of health care services.
This site offers a wide range of publications on issues
related to health insurance and the uninsured.
Start
Healthy, Stay Healthy
The Start Healthy, Stay Healthy campaign is a national
outreach effort conducted by the Center on Budget and
Policy Priorities, a private, nonprofit research and
policy organization based in Washington, D.C. The campaign
has been enlisting a wide array of community-based organizations,
health and human services providers, advocacy groups,
program administrators and others to identify children
from low-income working families who may be eligible
for free or low-cost health insurance programs. The
campaign also promotes coordination between newly enacted
state child health insurance programs and Medicaid to
ensure that children are not in danger of being left
without coverage. A community outreach handbook is available,
that includes fact sheets, posters and flyers to help
spread the word about free and low-cost health insurance.
Also provides access to State insurance eligibility
forms for individual states.
100%
Campaign
Over 2 million children in California–more than
1 in 5–are uninsured. Children Now, Children's
Defense Fund and The Children's Partnership, with primary
support from The California Endowment, have joined in
a collaborative effort to ensure that all of California's
children obtain health coverage. The 100% Campaign is
using many strategies–including key partnerships
with the broadest possible range of community groups
and leaders, public education, new research, outreach
and policy analysis–to ensure that all of California's
children receive health coverage. While this site represents
a campaign in California, much of the information could
be useful to other regions and communities addressing
the issue of uninsured children.
The
Kaiser Commission on Medicaid and the Uninsured
The Commission functions as a policy institute and forum
for analyzing health care coverage and access for the
low-income population and assessing options for reform.
The Commission, begun in 1991, strives to bring increased
public awareness and expanded analytic effort to the
policy debate over health coverage and access, with
a special focus on Medicaid and the uninsured. This
site contains extensive information about the national
health insurance situation.
Covering Kids
This site gives information on the Robert Wood Johnson
Foundation (RWJF) funded project "Covering Kids".
The purpose of the project was to help states increase
the number of who benefit from health insurance coverage
programs. The site has links to state and local outreach
projects which can serve as examples for RC/EZ/ECs to
follow. It also provides a link to a new RWJF 4-year
initiative "Covering Kids and Families". Check
information on this site frequently to see if your state
was awarded a "Covering Kids and Families"
grant.
Health
Resources and Services Administration - Focus on Child
Health, A Compendium of Outreach Models
Here you can download (in Word Perfect or PDF) Reaching
Our Children A Compendium of Outreach Models . The
compendium is divided into two sections, one that provides
strategies used to increase enrollment in public health
care insurance programs, and one that describes community-based
projects aimed at increasing access to primary and preventive
care for children.
Families USA
- The Voice for Health Care Consumers
This web site provides information about children's
health, the uninsured, managed care, Medicare, Medicaid,
prescription drugs and communities of color. Families
USA also provides training and technical assistance
to, and work collaboratively with, state and community-based
organizations as they address critical health care problems
in their communities.
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