Content by Keyword: Uninsured

With assessments this small, workers of firms who pay the assessment are not automatically enrolled in an alternative plan.  Assessments of this level do not generate enough revenue to cover enrollment into alternative insurance programs.  Therefore, the reduction in the uninsured is fairly low, and the cost of the program is really born by empl

ASPE worked with The Lewin Group to model the coverage and cost impact of a national employer mandate.  The first analysis is modeled after the Massachusetts “fair share contribution” requirement, with a $295 assessment per employee for firms with 11 or more employees.  In order to avoid the assessment, firms must offer coverage to all emplo

Two states and one locality have successfully legislated and implemented employer mandates. 

The Employee Retirement Income Security Act of 1974 (ERISA) is a federal statute that regulates employer benefit plans, including health insurance benefits.  It does not require that employers provide a health insurance benefit, but for those that do it standardizes the treatment and administration of the benefit.  ERISA preempts all state laws

An employer mandate to provide health insurance coverage for employees can be implemented strictly as a mandate requiring compliance without any alternative options, or it can be implemented as a mandate to either provide coverage or pay a “penalty” in the form of a tax or assessment.  If significant enough, the penalty could be used to subsi

A national mandate to establish Section 125 plans would result in a significant cost impact regardless of the impact on the uninsured, because roughly 30 percent of workers who now have ESI are in a firm that has not established a section 125 plan (The Lewin Group, 2008).  The introduction of such a plan would result in decreased federal income a

A national mandate to establish Section 125 plans for employers with 10 or more workers would reduce the number of uninsured by 4.2 million (Figure 3).  Of the 50.1 million people who would newly participate in a Section 125 plan, 4.2 million would have been previously uninsured, 5.1 million would have been previously covered by a non-group plan,

Due to the recent interest in expanding Section 125 plans, ASPE worked with The Lewin Group to design and model a national mandate to establish Section 125 plans.  For the analysis, we assumed employees would be purchasing coverage in the non-group market through an employer Section 125 plan, with no contribution from the employer.  We provide t

As of the writing of this analysis, it is unclear how extending mandatory Section 125 plans to employees for the purchase of health insurance coverage on the individual (non-group) market fits with existing state regulations of the insurance market (Lewin, 2008).  Whether or not the employee is enrolling in group versus non-group coverage is an i

Section 125 plans (sometimes referred to as cafeteria plans), so named after Section 125 of the Internal Revenue Code enacted by Congress in 1978, are benefit plans offered by employers to their employees that allow employees to pay for certain benefits on a pre-tax basis.  When employers offer health insurance through a Section 125 plan, employe

A national premium subsidy program that includes the crowd-out provision described above would have a net federal cost of $91.8 billion dollars and a net state savings of $10.1 billion, for a total program cost of $81.7 billion (Figure 2).  States achieve savings as a result of reduced costs for state programs for the uninsured due to the decreas

A national premium subsidy program that includes the crowd-out provision described above would reduce the number of uninsured by approximately 15.5 million (Figure 1).  Of the 18.2 million who enroll, 15.5 would have been previously uninsured, 1.5 million would drop non-group coverage and endure 6 months “bare” before enrolling, and 1.2 would

Given the widespread interest in premium subsidy programs, ASPE worked with The Lewin Group to design and model a national premium subsidy program.  The premium subsidies, including individual/family contribution requirements, reflect the Massachusetts program’s premium subsidy schedule, and the benefits mimic those included in the Massachusett

Many states already have premium subsidy programs, and more are considering them.  In the spring of 2008 several states considered, either as part of state-based commission recommendations, or as gubernatorial or legislative proposals, implementing a premium subsidy program for low-income individuals, including such states as Virginia, Colorado,

Premium subsidy programs can be financed through state funds, federal funds, participant contributions and sometimes employer contributions.  Many programs are financed through state-only funds, based on legislative authority and appropriations.  Some state-only programs, such as the one in Pennsylvania, are funded in part with tobacco settlemen

There is wide variation among programs for how coverage is achieved.  Programs can be structured so that premium subsidies can be used for ESI only, for purchase of state-contracted benefit plans, or either depending on the participants’ access to ESI.  Some programs only enroll participants who have access to ESI (or whose employer agrees to

The amount of the subsidy can vary based on a variety of factors.  A subsidy may be a set dollar amount or it could be a percentage of a premium.  In addition, if a subsidy is going towards a premium payment for ESI coverage, the employer contribution may impact the subsidy amount.  Some states, particularly those that provide subsidies for ind

Eligibility guidelines for premium subsidy program participation vary widely, but income is a key consideration across all programs.  Premium subsidies are meant to provide increased access to coverage by improving health insurance affordability for populations for whom financial limitations make take-up less likely.  By definition, this populat

Premium subsidy programs provide financial support to individuals and families for the payment of health insurance premiums.  Participation is usually limited to low-income individuals with earnings that are no more than two or three times the Federal Poverty Level (FPL), with the exact income limit varying from program to program.  Subsidy amou

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with The Lewin Group to model and analyze the cost and coverage impacts of implementing various state health care reform proposals nationally.  The Lewin Group used their proprietary Health Benefits Simulation Model (HBSM) for the analysis.  All modeling done for