A proposal to cover the uninsured in California

Health Affairs

Volumn 26, Issue 1, 2007, Pages

  Halvorson, George C ^a,b   Crosson, Francis J ^c   Zatkin, Steve ^a,d  

^a Kaiser Foundation Health Plan Inc   (United States)

^b DIVISION OF RESEARCH   (United States)

^c Permanente Federation   (United States)

^d Kaiser Foundation Hospitals   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ECONOMICS; HEALTH CARE PLANNING; HEALTH CARE POLICY; HUMAN; INSURANCE; PATIENT; PRACTICE GUIDELINE; PREVENTIVE HEALTH SERVICE; PRIMARY HEALTH CARE; REVIEW; TERMINAL DISEASE; UNITED STATES;

CALIFORNIA; CATASTROPHIC ILLNESS; GUIDELINES; HEALTH CARE REFORM; HUMANS; MEDICALLY UNINSURED; PREVENTIVE HEALTH SERVICES; PRIMARY HEALTH CARE; STATE HEALTH PLANS; UNITED STATES; UNIVERSAL COVERAGE;

EID: 33846655412     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.1.w80     Document Type: Review

References (13)

1. E. Neuschler and R. Curtis, "Massachusetts-Style Coverage Expansion: What Would It Cost in California?" Issue Brief, April 2006, http://www.chcf.org/documents/insurance/MAStyleCovExpansionIB.pdf (accessed 29 June 2006).
2. The Lewin Group estimates a monthly average of 5.3 million uninsured people using the California-adjusted HBSM model.
3. A key determinant in the passage of the Massachusetts legislation was that the state would lose $385 million in federal funds unless uncompensated care funds were shifted to provide subsidies for coverage of the uninsured.
4. The Lewin Group analyzed the cost and enrollment impacts of the proposal, while the Kaiser Foundation Health Plan developed the various benefit plan cost estimates through its actuarial department.
5. Because the mandate is enforced through the tax system, we assumed that anyone with income tax withheld during the year would file state taxes and thus be covered under Medicaid, SCHIP, or CalPrime if eligible. Of those with incomes at or above 300 percent of poverty who have not purchased coverage (individually or through an employer), we assumed that uninsurable people would enroll in the high-risk pool (MRMIP) and the remainder in the default plan (CalCAT). Most CalPrime enrollees would be identified through the tax system. Enrollment for income-eligible legal residents who do not file taxes was simulated based on the reduction in the premium they would pay for coverage using a multivariate model of how changes in premiums affect the likelihood of taking up coverage. The model is consistent with an average price elasticity of -0.34, varying with income, age, and other characteristics.
6. For more information about the HBSM and its specific application to this proposal, see Appendix 1, available online at http://content.healthaffairs.org/ cgi/content/full/hlthaff.26.1.w80/DC2.
7. For more information about the health care sales and the in-lieu payroll taxes, see Appendix 2; ibid.
8. Neuschler and Curtis, "Massachusetts-Style Coverage Expansion";
9. and Families USA, Paying a Premium: The Added Cost of Care for the Uninsured, Pub. no. 05-101 (Washington: Families USA, 2005). Premium savings also depend on the scope of the benefit package.
10. For background on the Massachusetts reform and its political trade-offs, see a group of Health Affairs Web-Exclusive papers published 14 September 2006, available online at http://content.healthaffairs.org/cgi/content/full/ hlthaff.25.w420/DC2.
11. Article XIII, Section 2, California Constitution.
12. Article XVI, California Constitution.
13. The Lewin Group estimates that 85 percent of the uninsured (4.7 million of an average monthly 5.3 million) would be covered under this proposal. They also estimate all sources of coverage with a total monthly average population of 36.3 million. If 640,000 remain uninsured once the proposal is fully implemented, approximately 98 percent of all Californians would be covered.