Performance Improvement 2008. What Features Make Targeted Insurance Programs Successful With the Poor?


This study examined the efforts in six States to develop market-based, low cost health insurance products targeted to low income workers. In addition to providing detailed case studies, the study compared the different approaches used in four broad areas: program design; program financing; methods to keep the program affordable; and program administration. Issues such as the uses of data, decisions about design of insurance products (including trade-off between costs and scope of benefits), administration of the proposed programs, sources of financing, the negotiations and agreements with safety net providers, and the extent of sign-up for low cost benefit packages were included.

Lessons learned from this cross-State comparison included: make realistic enrollment goals, pay attention to the whole package; carefully consider the employer/employee cost sharing requirements; consider implications for the State; marketing is critical; Individual means-testing is a barrier; anticipate higher than expected premiums; appreciate tension between adding benefits and keeping program costs low; consider the impact of limited or no premium subsidies; and know the target population.

Report Title: Efforts to Expand Coverage to the Uninsured: Program Design Challenges and Tradeoffs in Six States,
Agency Sponsor:
HRSA, Health Resources and Services Administration
Federal Contact: Jessica Townsend, 301-443-0371
Performer: Academy Health
PIC ID: 8386

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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