Subject: Studies in the News 07-04 (January 17, 2007)


CALIFORNIA RESEARCH BUREAU
CALIFORNIA STATE LIBRARY
Studies in the News
Health Supplement: Health Insurance


Contents This Week

Introductory Material HEALTH
   Coverage of employer health insurance
   Creative health coverage expansions
   Insurance in midsize firms
   Declining health insurance coverage
   Pay or play mandates
   Consumer-directed health plans
   Insurance industry health plan unveiled
   New local health plan concept
   Hidden costs of California's uninsured
   Discontent with growing health costs
   Tracking health care costs
   Survey backs guaranteed coverage
   Health care use in LA county
   One in five Californians uninsured
   Covering California's uninsured
   Characteristics of the uninsured
PREVIOUSLY IN STUDIES IN THE NEWS
   Uninsured children and health insurance
   Uninsured children and public health insurance
   Los Angeles Healthy Kids program
   Expanding health insurance coverage for children
   Instability of public health insurance coverage
   Healthy Kids programs evaluation
   Disparities in health care access
   Enrolling uninsured children
   Extending children's health insurance
   Children's health insurance programs
   Declining job-based health coverage
   Economics of employer mandated health care
   Cost of Massachusetts-style coverage
   Changes in employer-sponsored health insurance
   Children's Health Initiative programs
   HMOs lose cost advantage
   Massachusetts's universal health coverage
   Small business insuring Californians
   Gaps in coverage and care for minority adults
   Access to care for Hispanics
   Gaps in health insurance
   Uninsured children and families
   Increase cost for the uninsured
Introduction to Studies in the News

Studies in the News is a very current compilation of items significant to the Legislature and Governor's Office. It is created weekly by the State Library's Research Bureau to supplement the public policy debate in California’s Capitol. To help share the latest information with state policymakers, these reading lists are now being made accessible through the State Library’s website. This week's list of current articles in various public policy areas is presented below.

Service to State Employees:

  • When available, the URL for the full text of each item is provided.

  • California State Employees may contact the State Information & Reference Center (916-654-0206; cslsirc@library.ca.gov) with the SITN issue number and the item number [S#].

  • All other interested individuals should contact their local library - the items may be available there, or may be borrowed by your local library on your behalf.

The following studies are currently on hand:

HEALTH

INSURANCE

Snapshot: Employer-Based Insurance: Coverage and Cost. By Christine E. Eibner and others, RAND. (California HealthCare Foundation, Oakland, California) 2006. 25 p.

Full Text at: www.chcf.org/documents/insurance/SnapshotEmployerCostsCoverage2006.pdf

["About two-thirds of California businesses offer health insurance to at least some workers as a benefit of employment. These businesses account for 89 percent of California workers. This report addresses a range of issues, including how costs are distributed; which types of employers offer coverage; the number of workers enrolled; and how employer premiums vary among offering businesses. It also examines how employer costs would change if every business provided coverage for all full-time workers."]

[Request #S63026]

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From New England to the Golden Gate Bridge: A Look at Creative Coverage Expansions at the State and Local Levels. By Cristy Gallagher, New America Foundation. (The Foundation, Washington, DC) November 2006. 22 p.

Full Text at: www.newamerica.net/files/HPStatePaper_0.pdf

["One trend is for states to find ways to expand coverage by providing subsidies to enable small employers to offer insurance to their workers and their families.... Both Maine and Vermont have creatively reshaped the insurance market for those lacking employer coverage, offering subsidies for those who can not afford to purchase coverage ... Some states have set up programs specifically for individuals lacking access to employer based insurance. These include Utah, Pennsylvania, Oklahoma, and Wyoming.... Illinois, Tennessee, and Pennsylvania are implementing programs to enable all children to have health insurance."]

[Request #S64924]

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High Cost of Insurance Outweighs Other Barriers for Mid-Size Firms. By Naderah Pourat and Jay Ripps, UCLA Center for Health Policy Research. (The Center, Los Angeles, California) 2006. 12 p.

Full Text at: www.healthpolicy.ucla.edu/pubs/files/Midsize_Firms_RT.062606.pdf

["This brief characterizes California’s mid-size market and explores whether there are viable options for enhancing the current market dynamics and improving the ability of mid-size firms to provide affordable health insurance to their employees. The mid-size market is a relatively small sector, consisting of 6% of California firms and 17% of California employees.... Unlike large and small firms, California’s mid-size groups are thought to be particularly vulnerable due to lack of regulatory protection and lack of negotiating power. These firms typically purchase insurance on their own, without the benefit of purchasing coalitions or associations."]

[Request #S70201]

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Health Insurance Costs and Declining Coverage. By Tom Buchmueller and Rob Valletta. FRBSF Economic Letter. No. 2006-25. (Federal Reserve Bank of San Francisco, San Francisco, California) September 29, 2006. 4 p.

Full Text at: www.frbsf.org/publications/economics/letter/2006/el2006-25.pdf

[“This letter investigates the trend towards declining insurance coverage, focusing on the recent trends in employer-sponsored insurance coverage and costs and underlying changes in employee participation rates. It uses available research results to project long-term coverage declines in response to further cost increases.”]

[Request #S70202]

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Pay or Play Health Insurance Mandates: Lessons from California. By Aaron S. Yelowitz, Department of Economics, University of Kentucky. California Economic Policy. Vol. 2, No. 3. (Public Policy Institute of California, San Francisco, California) October 2006. 24 p.

Full Text at: www.ppic.org/content/pubs/cep/EP_1006AYEP.pdf

[“A study indicates that government-sponsored mandates requiring employer-provided health care could have damaging economic consequences for Californians. The study found the following trends: two-thirds of the money spent on employee health coverage by employers would have gone to individuals who already were insured; about 70,000 low-wage workers would have lost their jobs because their employers would have been obligated to pay more than 80 percent of insurance premium costs; and lowered wages. If forced to provide more expansive health coverage, it is likely that employers would lower their employees’ wages to compensate for the increased insurance costs.” California Capitol Hill Bulletin (November 3, 2006) 1.]

[Request #S70203]

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Behind the Slow Enrollment Growth of Employer-Based Consumer-Directed Health Plans. By Jon Gabel, Center for Studying Health System Change, and others. Issue Brief. No. 107. (The Center, Washington, DC) December 2006. 6 p.

Full Text at: www.hschange.org/CONTENT/900/900.pdf

[“U.S. workers prefer to enroll in PPO or HMO insurance plans rather than consumer-directed health plans. The study found that 39% of the 2.7 million U.S. residents enrolled in employer-sponsored, consumer-directed health plans were not offered other health insurance options. Among workers offered a selection of health insurance plans, including consumer-directed plans and other options such as PPOs or HMOs, 19% chose the consumer-directed plan.... Consumers might not choose consumer-driven plans because they are wary of being financially accountable for their health care choices. “ American Health Line (December 1, 2006) 1.]

[Request #S70204]

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We Believe Every American Should Have Access to Affordable Health Care: A Vision for Reform. By America’s Health Insurance Plans. (America’s Health Insurance Plans, Washington, DC) 2006. 7 p.

Full Text at: www.ahipbelieves.com/Portals/0/docs/vision_of_reform.pdf

[“The insurance industry unveiled a proposal to extend coverage to nearly 47 million uninsured persons. The proposal by the insurance trade group combines elements favored by Democrats with some that Republicans have backed. The plan would rely on a mixture of expanded federal and state programs and tax credits for workers and their families to purchase private health insurance and pay medical expenses. It would also provide federal grants to states that are trying to expand coverage for their residents. “ Los Angeles Times (November 14, 2006) A1.]

[Request #S70205]

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Report on County Adult Health Coverage Expansion Project. By Amy Carta, County of Santa Clara, Santa Clara Valley Health & Hospital System. (The County, San Jose, California) November 15, 2006. 8 p.

Full Text at: tinyurl.com/vqnpb

[“Santa Clara County, the valley's largest provider of health care for people without medical insurance, thinks it can get small businesses to do the right thing -- and make the county money in the bargain. Under the ‘Three Share Model’ plan, the county would make its health and hospital network -- and its 300 attending physicians -- available to low-wage workers of small businesses that currently do not offer health coverage. Participating employers and employees, in return, would pay monthly premiums. It remains at the conceptual stage until next spring, when the county will learn if it will be awarded state money, estimated at $10 million to $15 million, to launch the project. “ San Jose Mercury News (November 24, 2006) 1.]

[Request #S70206]

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A Premium Price: The Hidden Costs All Californians Pay in Our Fragmented Health Care System. By Peter Harbage and Len M. Nichols, New America Foundation. Issue Brief. No. 3. (The Foundation, Washington, DC) December 2006. 5 p.

Full Text at: www.newamerica.net/files/HealthIBNo3.pdf

[“Health insurance is the primary method Californians use to access and pay for health care. However, millions of Californians have inadequate health insurance or lack coverage entirely. When care is needed, the first inclination for these families is to delay treatment that is too costly and then hope for the best. And when hope is not enough, these families are forced to seek treatment that they often cannot afford. When medical bills go unpaid, many health care providers shift the cost onto those who can pay -- those with health insurance.”]

[Request #S70207]

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2006 Health Confidence Survey: Dissatisfaction With Health Care System Doubles Since 1998. By Ruth Helman, Mathew Greenwald & Associates, and Paul Fronstin, Employee Benefits Research Institute. (The Institute, Washington, DC) November 2006. 12 p.

Full Text at: www.ebri.org/pdf/notespdf/EBRI_Notes_11-20061.pdf

[“The annual survey found that more than half of those surveyed — 52% - were dissatisfied with health insurance costs, a sharp increase from 33% last year.... Of that group, 28% said that because of health-related costs, they had trouble paying for such basic necessities as housing, heat and food. The institute's poll found that workers regard their employer-sponsored coverage as an ever more valuable benefit, even as many new jobs come with no coverage and employers cut back or drop existing plans. Overall, the proportion of employees covered by a company plan dropped from 81% in 2001 to 77% in 2005.” Los Angeles Times (October 25, 2006) 1.]

[Request #S70208]

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"Tracking Health Care Costs: Continued Stability But at High Rates in 2005." By Paul B. Ginsburg and others. IN: Health Affairs, vol. 25, no. 6 (2006) pp.w486-w495.

Full Text at: content.healthaffairs.org/cgi/reprint/hlthaff.25.w486v1.pdf?

[“Health care spending per privately insured person increased 7.4 percent in 2005, marking the third year that the cost trend hovered between 7 and 8 percent following double-digit trends in 2001 and 2002. The trend for 2005 reflected increased growth in spending for hospital and physician care, offsetting a sharp drop in spending growth for prescription drugs. Hospital utilization trends accelerated, while price trends decelerated in 2005."]

[Request #S70209]

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Field Health Survey: Voter Satisfaction With and Concerns About the Health Care System: December 2006. By Mark DiCamillo and Mervin Field, Field Research Corporation. Field Poll Release. No. 2221. (The Corporation, San Francisco, California) January 3, 2007. 22 p.

Full Text at: www.field.com/fieldpollonline/subscribers/RLS2221.pdf

[“More than eight in 10 California voters think government should guarantee that everyone can get affordable health care coverage. The poll shows half of voters are generally satisfied with the current health care system. But 10 percent are uninsured themselves and nearly 40 percent are worried that they or someone close to them could be without coverage in the near future. And nearly 40 percent expect the problems to get worse. Nearly 80 percent of those polled said they thought the government has a responsibility to provide coverage for the poor.” Sacramento Bee (January 3, 2007) A3.]

[Request #S70210]

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Health Insurance, Health Care Use, and Health Status in Los Angeles County. By Marianne P. Bitler and Weiyi Shi, Public Policy Institute of California (The Institute, San Francisco, California) December 2006. 151 p.

Full Text at: www.ppic.org/content/pubs/report/R_1206MBR.pdf

[“As the Governor and state lawmakers seek ways to care for millions of Californians without medical insurance, a study says policy changes will be difficult to implement because of differences in how residents use the health care system.The report dispels some commonly held beliefs, finding that immigrants and their children generally don't seek care at hospitals and emergency rooms any more often than U.S.-born residents. ‘These findings suggest that concerns about immigrants and their children disproportionately using hospitals and ERs may not be well-founded for Los Angeles County.'" Los Angeles Daily News (December 21, 2006) 1.]

[Request #S70211]

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UNINSURED

One in Five Californians Were Uninsured in 2005 Despite Modest Gains in Coverage. By Jean Yoon and others, UCLA Center for Health Policy Research. (The Center, Los Angeles, California) October 2006. 4 p.

Full Text at: www.healthpolicy.ucla.edu/pubs/files/CAs_Uninsured_PB.100406.pdf

["Six and one-half million Californians were uninsured for all or some of 2005, a number that is as large as the combined populations of nine other states. The number of uninsured represents one in five children and nonelderly adults.... With one in five nonelderly Californians experiencing uninsurance during the year, the need for reforms of the health insurance system continues unabated."]

[Request #S64925]

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Covering California's Uninsured: Three Practical Options. By Rick Curtis and Ed Neuschler, Institute for Health Policy Solutions. Prepared for the California HealthCare Foundation. (The Foundation, Oakland, California) October 2006. 56 p.

Full Text at: tinyurl.com/y2595u

["Momentum is growing in California -— in both the public and private sectors -— to make health coverage affordable and available for all, or nearly all.... The authors propose three approaches to bringing California's uninsured into coverage. The key purpose of the analysis was to estimate the respective costs under each model to the government, individuals, and employers. The resulting reports are intended to inform policymakers in their development of proposals and to identify workable designs."]

[Request #S64926]

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Snapshot: California’s Uninsured. By Paul Fronstin, Employee Benefit Research Institute. (California Healthcare Foundation, Oakland, California) 2006. 20 p.

Full Text at: www.chcf.org/documents/insurance/CAUninsured06.pdf

[“California has a higher proportion of uninsured residents and lower rates of employer-based coverage than the nation. Almost 40% of California’s uninsured work for small employers with fewer than 25 workers. Seventy-one percent of the state’s uninsured children are in families where the head of household works full time, all year. Nearly 1 in 3 uninsured have family incomes over $50,000. Latinos, which represent more than half of California’s uninsured residents, are much more likely to be uninsured than any other ethnic group.”]

[Request #S64927]

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PREVIOUSLY IN STUDIES IN THE NEWS
[This section links to items in Studies in the News since the last Health Insurance Supplement.]

CHILDREN

Opening Doorways to Health Care for Children: 10 Steps to Ensure Eligible but Uninsured Children Get Health Insurance. By Dawn Horner and Beth Morrow, The Children’s Partnership. (Kaiser Commission on Medicaid and the Uninsured, Washington, DC) April 2006. 44 p.

Full Text at: www.kff.org/medicaid/upload/7506.pdf

["Seventy percent of uninsured children are eligible for public health coverage. This report lays out a plan for creating a series of enrollment doorways that make enrollment and renewal of children both routine and timely -- as close to automatic as possible. The recommendations require a combination of both state and federal action."]

[Request #S62215]

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"Enrolling Vulnerable, Uninsured but Eligible Children in Public Health Insurance: Association With Health Status and Primary Care Access." By Gregory D. Stevens and others. IN: Pediatrics, vol. 117, no. 4 (April 2006) pp. e751-e759.

Full Text at: pediatrics.aappublications.org/cgi/reprint/117/4/e751

["Given that more than two thirds of uninsured children in California are eligible for public health insurance coverage, this study examines differences in primary care access and health status between uninsured but eligible (UBE) children and insured children. This study demonstrates that UBE children in California have poorer access to care compared with enrollees, and those with the highest levels of risk have poorer health status. This suggests that providing insurance to these children (and particularly those with multiple risk factors) may lead to improved access and health for these vulnerable children." RAND Child Policy Update (May 2006) 1.]

[Request #S62708]

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What Do Parents Say about the Los Angeles Healthy Kids Program? Findings from the First Evaluation Focus Groups. By Ian Hill, the Urban Institute, and others. (The Institute, Washington, DC) March 2006. 45 p.

Full Text at: www.urban.org/UploadedPDF/410308_parents_say.pdf

["The focus groups explored parents' feelings about and experiences with Healthy Kids, which extends coverage to uninsured children from birth through age 18 in families with income below 300 percent of the federal poverty level who are ineligible for Medicaid or SCHIP. Researchers found that the program is providing families with a highly valued service in the form of comprehensive health insurance coverage, permitting their children easier access to care, making health services more affordable, and increasing options for where and when to obtain care." Urban Institute's Health Policy Newsletter (May 25, 2006) 1.]

[Request #S62709]

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Estimated Cost and Coverage Impacts of Four Proposals to Expand Health Insurance Coverage for Children in California. By the Lewin Group. Prepared for the California Endowment. (The Endowment, Los Angeles, California) April 20, 2006. 77 p.

Full Text at: www.calendow.org/reference/publications/pdf/access/LEWIN_apr2006.pdf

["This study presents estimates of the cost and coverage impacts of four proposals to expand health insurance coverage in California, with particular emphasis on the effect these approaches would have on children. The four proposals studied are in varying stages of development and are likely to be revised throughout the policy debate."]

[Request #S62828]

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Instability of Public Health Insurance Coverage for Children and their Families: Causes, Consequences, and Remedies. By Laura Summer and Cindy Mann, Georgetown University Health Policy Institute. Commonwealth Fund. Pub. No. 935. (The Fund, New York, New York) June 2006. 66 p.

Full Text at: www.cmwf.org/usr_doc/Summer_instabilitypubhltinschildren_935.pdf

["This report examines the extent, causes, and consequences of instability in public coverage programs for children and families. It focuses particularly on the phenomenon of 'churning,' which occurs when individuals lose and regain coverage in a short period of time. It also looks at strategies to make public program coverage more stable for children and families.... Coverage instability can be averted to a significant degree by adopting key policies and procedures, like limiting the frequency of required renewals; developing easy, seamless transitions among public coverage programs; and setting affordable limits on premium costs."]

[Request #S63111]

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Monitoring the Expansion of Children’s Health Initiatives in California. By Gregory D. Stevens, Keck School of Medicine, University of Southern California, and others. (The California Endowment, Los Angeles, California) May 2006. 8 p.

Full Text at: www.calendow.org/reference/publications/pdf/access/MonitoringtheExpansionFINAL.pdf

["Healthy Kids programs, both operational and planned, have now emerged in 31 counties and have enrolled more than 85,000 children, changing the insurance landscape for children in the state. This evaluation brief describes the experiences of and challenges faced by these innovative programs."]

[Request #S63415]

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Improving Children's Health: Understanding Children’s Health Disparities and Promising Approaches to Address Them. By the Children's Defense Fund. (The Fund, Washington, DC) 2006. 93 p.

Full Text at: cdf.convio.net/site/DocServer/CDF_Improving_Children_s_Health_FINAL.pdf?docID=1781

["Despite work to close gaps, there remain racial and ethnic disparities in access to health care services and insurance coverage among Latino, Black, and White children. For example, Latino kids are more than three times as likely and Black children are almost 50 percent more likely than White children to be uninsured.... Promising approaches include the following: creating health partnerships with schools, churches and other community centers; using community health care workers; using mobile programs; focusing on increasing preventative care; and strengthening policies." Connect for Kids (June 12, 2006) 1.]

[Request #S63708]

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California’s Express Enrollment Program: Lessons from the Medi-Cal/School Lunch Pilot Program -- And Suggested Next Steps in Making Enrollment Gateways Efficient and Effective. By Dawn Horner and Dania Wasongarz. (The Children’s Partnership, Santa Monica, California) July 2006. 12 p.

Full Text at: www.expresslaneinfo.org/AM/Template.cfm?Section=Home&CONTENTID=9682&TEMPLATE=/CM/ContentDisplay.cfm

["This issue brief documents results from California’s Express Enrollment pilot program to enroll uninsured children into health insurance through school lunch programs. It reviews program activities, assesses its overall effectiveness, and applies lessons to state efforts to use public programs to enroll uninsured children into health coverage."]

[Request #S63710]

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SCHIP Buy-In Programs. By Cynthia Pernice and David Bergman, National Academy for State Health Policy. (The Academy, Portland, Maine) 2006. 5 p.

Full Text at: www.nashp.org/Files/SCHIP_Buy-in_programs_2006.pdf

["The SCHIP buy-in programs operate in seven states. The programs augment SCHIP, and are intended to fill a gap in children’s health coverage when families leave SCHIP due to a loss of financial eligibility. Six of the seven states with buy-in programs pass on the full cost of administering the program to the families participating in the program. They do this by charging participating families a premium that covers both the amount the state pays for the health care coverage and the cost to administer the program. "]

[Request #S64608]

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Children's Health Insurance Programs: Facts and Figures. By the California HealthCare Foundation. (The Foundation, Oakland, California) 2006. 24 p.

Full Text at: www.chcf.org/documents/policy/ChildrensHealthInsuranceProgramsFactsFigures.pdf

[Includes: "Major Milestones Affecting Medi-Cal and Healthy Families Coverage;" "Sources of Coverage for California Children Under 19;" "State Comparison of Sources of Coverage for Children;" "Rates of Uninsured Children by State;" "Enrollee Profile: Race and Ethnicity;" and others.]

[Request #S64612]

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INSURANCE

Declining Job-based Health Coverage in the United States and California: A Crisis for Working Families. By Arindrajit Dube and others, Center for Labor, Research and Education, University of California, Berkeley. (The Center, Berkeley, California) January 2006. 67 p.

Full Text at: laborcenter.berkeley.edu/healthcare/declining_coverage06.pdf

["This report evaluates the extent of employer-based health coverage in the US and California. Information is given on: coverage demographics (by race/ethnicity, age, education, gender, income levels), type (public, private, employer-based), coverage trends (from 2000 to projected trends of 2010), implications for continued decline in coverage, and more."]

[Request #S61148]

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Employer Mandates and the Health Care Crisis: Economic Impacts in California and the Bay Area. By Sean Randolph and others, Bay Area Economic Forum. (The Forum, San Francisco, California) January 2006. 18 p.

Full Text at: www.bayeconfor.org/pdf/HealthCareEmployerMandatesJan25.pdf

["Enacting a mandate within a single jurisdiction, such as a city or county, may cause some companies to relocate.... Most mandates would not include the large numbers of Californians who are self-employed, undocumented immigrants, or temporary, part-time, or seasonal workers.... Because government mandates can negatively impact city business climates, alternative local approaches for expanding health coverage are needed."]

[Request #S61623]

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Massachusetts-Style Coverage Expansion: What Would it Cost in California? By Ed Neuschler and Rick Curtis, Institute for Health Policy Solutions. (The Institute, San Mateo, California) April 2006.

["Providing health insurance for all Californians under a plan similar to what Massachusetts recently adopted would cost about $9.4 billion more in this state. Earlier this month, Massachusetts became the first state to require individuals to carry health insurance or face financial penalties. The state doesn't expect much new public funding will be needed because it plans to redirect money spent on uncompensated care toward helping low-income people buy insurance.... Socioeconomic and demographic differences between the states account for the disparity, the study found." San Francisco Chronicle (April 27, 2006) 1.]

Report. 16 p.
http://www.ihps.org/pubs/2006_Apr_CHCF_MA_Style_Brief_Final.pdf

Executive Summary. 3 p.
http://www.ihps.org/pubs/2006_Apr_CHCF_Exec_Sum.pdf

[Request #S61923]

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Shifting Ground: Changes in Employer-Sponsored Health Insurance. By the State Health Access Data Assistance Center, University of Minnesota School of Public Health. Prepared for the Robert Wood Johnson Foundation. (The Foundation, Princeton, New Jersey) 2006. 45 p.

Full Text at: www.rwjf.org/newsroom/CTUWFinalResearchReport2006.pdf

["California workers are increasingly turning down health insurance offered by their employers, according to this study. About 82 percent of California workers accepted their employer's coverage in 2003, down from 87 percent in 1998. Nationally, the percentage of workers who accepted their employers' plans dropped to 80 from 85 percent during that same period.... More workers are declining employer-backed plans largely because they are required to contribute more money for their coverage. This shift affects not only the health of workers but also the vitality of the companies that employ them." San Francisco Chronicle (May 5, 2006) 1.]

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Policy Framework for Outreach, Enrollment, Retention and Utilization for Health Care Coverage in California. By Caroline Rivas and others, Community Health Councils. (The California Endowment, Los Angeles, California) May 2006. 27 p.

Full Text at: www.calendow.org/reference/publications/pdf/access/PolicyFrameworkOERUFINAL2.pdf

["This report describes the experiences and successes of local programs, such as Children's Health Initiatives, in providing health coverage to all children and families throughout California. The findings can help increase the knowledge and capacity to ensure the effectiveness of outreach, enrollment and retention policies, systems and strategies."]

[Request #S63414]

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California Employer Health Benefits Survey. By the California HealthCare Foundation. (The Foundation, Oakland, California) November 2006. 44 p.

Full Text at: www.chcf.org/documents/insurance/EmployerBenefitsSurvey06.pdf

[“After years of consistently paying less than HMO members in other states, California consumers in employer-sponsored HMO plans now pay about the same as the national average — about $340 a month for single coverage.... In the rest of the country, HMO premiums cost about the same as other health plans. But HMOs' price advantage in California is due more to the rapid rise in costs of other plans than managed care's ability to keep premiums down, and that could be a sign of trouble.” Los Angeles Times (November 30, 2006) 1.]

[Request #S65226]

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Roadmap to Coverage: Synthesis of Findings. By John Holahan and others, The Urban Institute. (The Institute, Washington, DC) October 2005. 50 p.

Full Text at: www.urban.org/UploadedPDF/411327_roadmap_synthesis.pdf

["This report pulls together all the research done for the landmark Roadmap initiative in Massachusetts. It describes three policy approaches that would achieve universal health coverage in the state, implementation issues and options, the building blocks for coverage expansion, and the mandate alternatives. The cost and coverage estimates were produced using the Health Insurance Reform Simulation Model, developed by Urban Institute researchers. The report also discusses options for financing the increased coverage, the likely benefits from universal coverage, and the broader economic effects." Urban Institute Update (May 18, 2006) 1.]

[Request #S79601]

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Coverage Expansion: Is Small Business the Key to Insuring More Californians? By California HealthCare Foundation. (The Foundation, Oakland, California) November 2005. 9 p.

Full Text at: www.chcf.org/documents/insurance/IsSmallBusinessTheKeyToInsuringCalifornians.pdf

["This brief concludes that as a focal point for addressing the problem of California's uninsured, the small business market offers at best a small target. While some gains are possible, they are likely to be both limited in scope and difficult to achieve."]

[Request #S79602]

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MINORITIES

Health Care Disconnect: Gaps in Coverage and Care for Minority Adults. By Michelle M. Doty and Alyssa L. Holmgren, The Commonwealth Fund. (The Fund, Washington, DC) August 2006. 12 p.

Full Text at: www.cmwf.org/usr_doc/941_Doty_hlt_care_disconnect_disparities_issue_bri.pdf

["The analysis finds that uninsured rates for Hispanic and African American adults are one-and-a-half to three times greater than the rate for white adults. Nearly two-thirds (62%) of working-age Hispanics and one-third (33%) of African Americans were uninsured at some point during 2005, compared with 20 percent of working-age whites.... Along with expanded insurance coverage, policies promoting continuity in patients’ relationships with health care providers also are needed to reduce disparities in access."]

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Health Coverage and Access to Care for Hispanics in "New Growth Communities" and "Major Hispanic Centers." By Peter Cunningham, Center for Studying Health System Change, and others. (The Kaiser Commission on Medicaid and the Uninsured, Washington, DC) September 2006. 36 p.

Full Text at: www.kff.org/uninsured/upload/7551.pdf

["Hispanics are more likely than other groups to encounter problems accessing timely and necessary health care. While the overwhelming majority of Hispanics work, they are much less likely than other groups to have health coverage because a large number of recent immigrants are employed in low-wage jobs that do not offer such benefits.... The problem ... is made worse by a shift in the nation's Hispanic population from large urban centers to smaller, rural towns that until recently had no or few Spanish-speaking residents. Communities that have little experience in caring for Hispanics may be less prepared to meet their health needs." HeraldToday.com (September 22, 2006) 1.]

[Request #S64527]

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UNINSURED

Gaps in Health Insurance: An All-American Problem. By Sara R. Collins and others, The Commonwealth Fund. (The Fund, New York, New York) April 2006. 38 p.

Full Text at: www.cmwf.org/usr_doc/Collins_gapshltins_920.pdf

["The number of moderate-to-middle-income Americans of working age who lack health insurance has risen dramatically in recent years. Forty-one percent of adults with incomes between $20,000 and $40,000 a year did not have health insurance for at least part of 2005, up from 28 percent without coverage in 2001.... The report illustrates how employers are dropping health coverage or are offering insurance plans that are too expensive for many workers to afford." San Francisco Chronicle (April 26, 2006) 1.]

[Request #S62523]

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Why Do People Lack Health Insurance? By John A. Graves and Sharon K. Long, The Urban Institute. Health Policy Online. No. 14. (The Institute, Washington, DC) 2006. 12 p.

Full Text at: www.urban.org/UploadedPDF/411317_lack_health_ins.pdf

["The authors find that in 2004 less than three percent of the uninsured saw no need for health insurance, while well over half stated that the high cost of coverage was a reason for lacking insurance. The authors also report that the share of the uninsured citing the high cost of coverage as a barrier to obtaining insurance has risen substantially over time, increasing more than eight percentage points for uninsured nonelderly adults, and by over six percentage points for uninsured children." Urban Institute's Health Policy Newsletter (May 25, 2006) 1.]

[Request #S63112]

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Analysis Finds that Cost to Care for California's Uninsured Could Increase By $8 Billion Over Next Five Years. By the California Policy Institute, University of Southern California. (The Institute, Sacramento, California) September 7, 2005. 3 p.

[The USC California Policy Institute has found that total spending in California on the uninsured by all payers could need to increase by $8.2 billion from 2005 to 2010 to maintain the same level of care offered to the uninsured today. This spending is not what could be needed to reduce the numbers of uninsured; rather, it is spending needed to provide the same level of care given today to California's uninsured, given medical inflation and the increase numbers of uninsured."]

[Request #S79603]

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