Challenges of State Health Reform: Variations in Ten States

Health Affairs

Volumn 17, Issue 1, 1998, Pages 191-200

  Cantor, Joel C ^b   Long, Stephen H ^a   Marquis, M Susan ^a  

^a RAND CORPORATION   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; CHILD; EPIDEMIOLOGY; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH STATUS; HUMAN; INSURANCE; MIDDLE AGED; PATIENT; STATISTICS; UNITED STATES;

ADULT; CHILD; HEALTH CARE REFORM; HEALTH CARE SURVEYS; HEALTH STATUS; HUMANS; INSURANCE COVERAGE; MEDICALLY UNINSURED; MIDDLE AGED; STATE HEALTH PLANS; UNITED STATES;

EID: 0031601746     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.1.191     Document Type: Article

References (30)

1. See, for example, T. Skocpol, "The Rise and Resounding Demise of the Clinton Plan," Health Affairs (Spring 1995): 66-85; and H. Heclo, "The Clinton Health Plan: Historical Perspective," Health Affairs (Spring 1995): 86-98.
2. See, for example, T. Skocpol, "The Rise and Resounding Demise of the Clinton Plan," Health Affairs (Spring 1995): 66-85; and H. Heclo, "The Clinton Health Plan: Historical Perspective," Health Affairs (Spring 1995): 86-98.
3. See, for example, D.L. Rogal and W.D. Helms, "State Models: Tracking States' Efforts to Reform Their Health Systems," Health Affairs (Summer 1993): 27-30; E. Friedman, "Getting a Head Start: The States and Health Care Reform," Journal of the American Medical Association (16 March 1994): 875-878; D. Neubauer, "Hawaii: A Pioneer in Health System Reform," Health Affairs (Summer 1993): 31-39; H.M. Leichter, "Minnesota: The Trip from Acrimony to Accommodation," Health Affairs (Summer 1993): 48-58; and R.A. Crittenden, "State Report: Recent Action in Washington and Oregon," Health Affairs (Summer 1995): 302-305.
4. See, for example, D.L. Rogal and W.D. Helms, "State Models: Tracking States' Efforts to Reform Their Health Systems," Health Affairs (Summer 1993): 27-30; E. Friedman, "Getting a Head Start: The States and Health Care Reform," Journal of the American Medical Association (16 March 1994): 875-878; D. Neubauer, "Hawaii: A Pioneer in Health System Reform," Health Affairs (Summer 1993): 31-39; H.M. Leichter, "Minnesota: The Trip from Acrimony to Accommodation," Health Affairs (Summer 1993): 48-58; and R.A. Crittenden, "State Report: Recent Action in Washington and Oregon," Health Affairs (Summer 1995): 302-305.
5. See, for example, D.L. Rogal and W.D. Helms, "State Models: Tracking States' Efforts to Reform Their Health Systems," Health Affairs (Summer 1993): 27-30; E. Friedman, "Getting a Head Start: The States and Health Care Reform," Journal of the American Medical Association (16 March 1994): 875-878; D. Neubauer, "Hawaii: A Pioneer in Health System Reform," Health Affairs (Summer 1993): 31-39; H.M. Leichter, "Minnesota: The Trip from Acrimony to Accommodation," Health Affairs (Summer 1993): 48-58; and R.A. Crittenden, "State Report: Recent Action in Washington and Oregon," Health Affairs (Summer 1995): 302-305.
6. See, for example, D.L. Rogal and W.D. Helms, "State Models: Tracking States' Efforts to Reform Their Health Systems," Health Affairs (Summer 1993): 27-30; E. Friedman, "Getting a Head Start: The States and Health Care Reform," Journal of the American Medical Association (16 March 1994): 875-878; D. Neubauer, "Hawaii: A Pioneer in Health System Reform," Health Affairs (Summer 1993): 31-39; H.M. Leichter, "Minnesota: The Trip from Acrimony to Accommodation," Health Affairs (Summer 1993): 48-58; and R.A. Crittenden, "State Report: Recent Action in Washington and Oregon," Health Affairs (Summer 1995): 302-305.
7. See, for example, D.L. Rogal and W.D. Helms, "State Models: Tracking States' Efforts to Reform Their Health Systems," Health Affairs (Summer 1993): 27-30; E. Friedman, "Getting a Head Start: The States and Health Care Reform," Journal of the American Medical Association (16 March 1994): 875-878; D. Neubauer, "Hawaii: A Pioneer in Health System Reform," Health Affairs (Summer 1993): 31-39; H.M. Leichter, "Minnesota: The Trip from Acrimony to Accommodation," Health Affairs (Summer 1993): 48-58; and R.A. Crittenden, "State Report: Recent Action in Washington and Oregon," Health Affairs (Summer 1995): 302-305.
8. J. Holahan et al., "Insuring the Poor through Section 1115 Medicaid Waivers," Health Affairs (Spring 1995): 199-216; B.C. Vladeck, "Medicaid 1115 Demonstrations: Progress through Partnership," Health Affairs (Spring 1995): 217-220; and "State Children's Health Insurance Program," Title XXI, Social Security Act, 1997, sec. 2101(a).
9. J. Holahan et al., "Insuring the Poor through Section 1115 Medicaid Waivers," Health Affairs (Spring 1995): 199-216; B.C. Vladeck, "Medicaid 1115 Demonstrations: Progress through Partnership," Health Affairs (Spring 1995): 217-220; and "State Children's Health Insurance Program," Title XXI, Social Security Act, 1997, sec. 2101(a).
10. J. Holahan et al., "Insuring the Poor through Section 1115 Medicaid Waivers," Health Affairs (Spring 1995): 199-216; B.C. Vladeck, "Medicaid 1115 Demonstrations: Progress through Partnership," Health Affairs (Spring 1995): 217-220; and "State Children's Health Insurance Program," Title XXI, Social Security Act, 1997, sec. 2101(a).
11. J. Holahan, C. Winterbottom, and S. Rajan, "A Shifting Picture of Health Insurance Coverage," Health Affairs (Winter 1995): 253-264; P.W. Newacheck, D.C. Hughes, and M. Cisternas, "Children and Health Insurance: An Overview of Recent Trends," Health Affairs (Spring 1995): 244-254; D. Rowland et al., "A Profile of the Uninsured in America," Health Affairs (Spring II 1994): 283-287; and S.H. Long and M.S. Marquis, "The Uninsured Access Gap and the Cost of Universal Coverage," Health Affairs (Spring II 1994): 211-220.
12. J. Holahan, C. Winterbottom, and S. Rajan, "A Shifting Picture of Health Insurance Coverage," Health Affairs (Winter 1995): 253-264; P.W. Newacheck, D.C. Hughes, and M. Cisternas, "Children and Health Insurance: An Overview of Recent Trends," Health Affairs (Spring 1995): 244-254; D. Rowland et al., "A Profile of the Uninsured in America," Health Affairs (Spring II 1994): 283-287; and S.H. Long and M.S. Marquis, "The Uninsured Access Gap and the Cost of Universal Coverage," Health Affairs (Spring II 1994): 211-220.
13. J. Holahan, C. Winterbottom, and S. Rajan, "A Shifting Picture of Health Insurance Coverage," Health Affairs (Winter 1995): 253-264; P.W. Newacheck, D.C. Hughes, and M. Cisternas, "Children and Health Insurance: An Overview of Recent Trends," Health Affairs (Spring 1995): 244-254; D. Rowland et al., "A Profile of the Uninsured in America," Health Affairs (Spring II 1994): 283-287; and S.H. Long and M.S. Marquis, "The Uninsured Access Gap and the Cost of Universal Coverage," Health Affairs (Spring II 1994): 211-220.
14. J. Holahan, C. Winterbottom, and S. Rajan, "A Shifting Picture of Health Insurance Coverage," Health Affairs (Winter 1995): 253-264; P.W. Newacheck, D.C. Hughes, and M. Cisternas, "Children and Health Insurance: An Overview of Recent Trends," Health Affairs (Spring 1995): 244-254; D. Rowland et al., "A Profile of the Uninsured in America," Health Affairs (Spring II 1994): 283-287; and S.H. Long and M.S. Marquis, "The Uninsured Access Gap and the Cost of Universal Coverage," Health Affairs (Spring II 1994): 211-220.
15. For estimates based on pooling adjacent years of the Current Population Survey, see C. Winterbottom, D.W. Liska, and K.M. Obermaier, State-Level Databook on Health Care Access and Financing, 2d ed. (Washington: Urban Institute, 1995); and J.D.C. Cartland and B.K. Yudkowsky, "State Estimates of Uninsured Children," Health Affairs (Spring 1993): 144-151. For a comparison of the CPS estimates and those from the survey data used in the present paper, see S.H. Long and M.S. Marquis, "Some Pitfalls in Making Cost Estimates of State Health Insurance Coverage Expansions," Inquiry (Spring 1996): 85-91. For information about insurance coverage and access to care for the low-income population in five states., see C. Schoen et al., "Insurance Matters for Low-Income Adults: Results from a Five-State Survey," Health Affairs (September/October 1997): 163-171.
16. For estimates based on pooling adjacent years of the Current Population Survey, see C. Winterbottom, D.W. Liska, and K.M. Obermaier, State-Level Databook on Health Care Access and Financing, 2d ed. (Washington: Urban Institute, 1995); and J.D.C. Cartland and B.K. Yudkowsky, "State Estimates of Uninsured Children," Health Affairs (Spring 1993): 144-151. For a comparison of the CPS estimates and those from the survey data used in the present paper, see S.H. Long and M.S. Marquis, "Some Pitfalls in Making Cost Estimates of State Health Insurance Coverage Expansions," Inquiry (Spring 1996): 85-91. For information about insurance coverage and access to care for the low-income population in five states., see C. Schoen et al., "Insurance Matters for Low-Income Adults: Results from a Five-State Survey," Health Affairs (September/October 1997): 163-171.
17. For estimates based on pooling adjacent years of the Current Population Survey, see C. Winterbottom, D.W. Liska, and K.M. Obermaier, State-Level Databook on Health Care Access and Financing, 2d ed. (Washington: Urban Institute, 1995); and J.D.C. Cartland and B.K. Yudkowsky, "State Estimates of Uninsured Children," Health Affairs (Spring 1993): 144-151. For a comparison of the CPS estimates and those from the survey data used in the present paper, see S.H. Long and M.S. Marquis, "Some Pitfalls in Making Cost Estimates of State Health Insurance Coverage Expansions," Inquiry (Spring 1996): 85-91. For information about insurance coverage and access to care for the low-income population in five states., see C. Schoen et al., "Insurance Matters for Low-Income Adults: Results from a Five-State Survey," Health Affairs (September/October 1997): 163-171.
18. For estimates based on pooling adjacent years of the Current Population Survey, see C. Winterbottom, D.W. Liska, and K.M. Obermaier, State-Level Databook on Health Care Access and Financing, 2d ed. (Washington: Urban Institute, 1995); and J.D.C. Cartland and B.K. Yudkowsky, "State Estimates of Uninsured Children," Health Affairs (Spring 1993): 144-151. For a comparison of the CPS estimates and those from the survey data used in the present paper, see S.H. Long and M.S. Marquis, "Some Pitfalls in Making Cost Estimates of State Health Insurance Coverage Expansions," Inquiry (Spring 1996): 85-91. For information about insurance coverage and access to care for the low-income population in five states., see C. Schoen et al., "Insurance Matters for Low-Income Adults: Results from a Five-State Survey," Health Affairs (September/October 1997): 163-171.
19. Robert Wood Johnson Foundation, Call for Proposals: State Initiatives in Health Care Financing Reform (Princeton, N.J.: RWJF, October 1991).
20. Robert Wood Johnson Foundation, State Health Care Reform: Looking Back toward the Future (Princeton, N.J.: RWJF, September 1997).
21. J.C. Cantor, S.H. Long, and M.S. Marquis, "Private Employment-Based Health Insurance in Ten States," Health Affairs (Summer 1995): 199-211.
22. For details of the survey design and methods, see Mathematica Policy Research, Survey Design and Data Collection Methods for the Robert Wood Johnson Foundation's Family Survey on Health Insurance (Princeton, N.J.: MPR, 14 September 1994). The data cleaning procedures are described in L.M. Andrews, S.H. Long, and M.S. Marquis, Data Cleaning Procedures for the 1993 Robert Wood Johnson Foundation Family Health Insurance Survey, MR-862-RWJ (Santa Monica, Calif.: RAND, 1997).
23. For details of the survey design and methods, see Mathematica Policy Research, Survey Design and Data Collection Methods for the Robert Wood Johnson Foundation's Family Survey on Health Insurance (Princeton, N.J.: MPR, 14 September 1994). The data cleaning procedures are described in L.M. Andrews, S.H. Long, and M.S. Marquis, Data Cleaning Procedures for the 1993 Robert Wood Johnson Foundation Family Health Insurance Survey, MR-862-RWJ (Santa Monica, Calif.: RAND, 1997).
24. In addition to the customary types of insurance coverage collected in national surveys (Medicare, Medicaid, Civilian Health and Medical Program of the Uniformed Services, Department of Veterans Affairs, employment-based, and other private), the survey included state-specific probes for special subsidized insurance programs by name in states where they were available.
25. These comparisons do not directly adjust for differences among the states in their demographic profiles. However, there is some age standardization in limiting the comparisons to persons under age sixty-five and in comparing adults and children separately. Nonetheless, there may be differences in the composition of the states' populations that relate both to insurance status and access.
26. In contrast, Cathy Schoen and colleagues, in "Insurance Matters for Low-Income Adults," found that differences in the number of uninsured among low-income adults in the five states included in the Kaiser/Commonwealth survey were mirrored by differences in Medicaid coverage, rather than by differences in private insurance. The Kaiser/Commonwealth survey was administered after recent expansions in the Medicaid program in several of the states. In addition, differences in the populations covered in the two surveys (all persons versus the low-income population) might have contributed to the different findings.
27. The survey did not include questions about physical limitations among children.
28. American Cancer Society, Cancer Facts and Figures - 1997 (Atlanta, Ga.: ACS, 1997), 29. Children were classified as not being in compliance with recommended immunizations if they were reported as not having received any one of the following vaccinations: diphtheria, pertussis, and tetanus (DPT); poliovirus; or measles, mumps, and rubella (MMR). Age-specific immunization recommendations are based on Centers for Disease Control and Prevention, "Immunization of Adolescents: Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association," Morbidity and Mortality Weekly Report (22 November 1996): 3.
29. American Cancer Society, Cancer Facts and Figures - 1997 (Atlanta, Ga.: ACS, 1997), 29. Children were classified as not being in compliance with recommended immunizations if they were reported as not having received any one of the following vaccinations: diphtheria, pertussis, and tetanus (DPT); poliovirus; or measles, mumps, and rubella (MMR). Age-specific immunization recommendations are based on Centers for Disease Control and Prevention, "Immunization of Adolescents: Recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association," Morbidity and Mortality Weekly Report (22 November 1996): 3.
30. See S. Rosenbaum et al., "The Children's Hour: The State Children's Health Insurance Program," Health Affairs (January/February 1998): 75-89.