October 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
The Lewin Group assisted the state of Vermont in developing options to expand insurance coverage in the state under the recent State Planning Grant program funded through the Health Resources and Services Administration (HRSA). This report describes the activities conducted to research the characteristics of uninsured Vermonters and the current state of the insurance, employer, and health care provider marketplaces. Additionally, this report contains the findings of the research as well as a summary of the various options developed under the HRSA grant.
Client Area: State and Local Governments
Expertise Area: Health Reform
August 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
For the state of Vermont, The Lewin Group explored the expected costs and impacts of a single-payer program in which all state residents are covered under a single public program funded primarily with an employer payroll tax.
This report presents The Lewin Group's analysis of the financial impact of a single-payer program on various payers for health care including state, local, and federal governments. It includes estimates of the financial impact of the proposal on employers by industry and firm size, and of the impact of the plan on household health spending by age, income level, and other characteristics.
Client Area: State and Local Governments
Expertise Area: Health Reform
September 2000
Robert Wood Johnson Foundation
In January of 2000, the Robert Wood Johnson Foundation (RWJF) sponsored the "Health Coverage 2000" conference at which eight major health care organizations and associations introduced proposals to expand health insurance coverage. Some of those proposals were introduced as the next steps toward universal health coverage and two of them would incrementally phase in universal insurance coverage by the middle of this decade. The incremental reform proposals included various expansions of Medicaid and the State Children's Health Insurance Programs (SCHIP), changes in tax subsidies for insurance including modifying the current tax exclusions and/or introducing tax credits for health insurance, and expansion of high-risk pools. Lewin was asked to estimate the cost and coverage impacts of the eight proposals. Assuming full implementation in 2001, Lewin estimated that the incremental reform proposals would cost between $15.4 billion and $59.1 billion and would reduce the number of uninsured by 7.3 million to about 19 million persons. Therefore, the incremental reform proposals would cover no more than about 40 percent of the uninsured. The universal coverage programs would cost between $324 billion and $454 billion per year. The incremental reform proposals specified no new revenue sources to cover the cost of the programs. However, the universal coverage proposals did include new revenues that would cover most if not all of the costs of the programs.
Client Area: Foundations
Expertise Area: Health Reform
May 2000
Maryland Citizens' Health Initiative Education Fund
Lewin contact: John Sheils
The purpose of this analysis was to explore the expected costs and impacts of two alternative universal health reform plans for Maryland. Both of these reform scenarios would greatly redistribute health care costs across families in various income groups by shifting from today's premium based system to a tax based system where individual payments for health coverage increase in proportion to income. In this report, we present our analyses of the financial impact of these health reform models on various payers for health care including state, local, and federal governments.
Client Area: Associations
Expertise Area: Health Reform
January 2000
Robert Wood Johnson Foundation
This report is designed to help the executive leadership of safety-net organizations assess the benefits of, and determine whether or not to invest in, care management programs. It also provides a "road map" for the design and implementation of care management programs. The report explains the business environment that supports investments in care management programs for the indigent, chronically ill, uninsured population. Additionally, it draws on the experiences of safety-net providers to help decision-makers assess the value of these programs in their environment. Using results from expert interviews, case studies, site visits, and the successes and challenges of 24 safety-net providers, the how-to guide specifically describes how care management programs are developed and provides a sampling of tools designed by health centers, hospital networks, and health plans to enable others to build on these efforts.
Client Area: Foundations
Expertise Area: Health Reform
October 1999
National Coalition on Health Care
In this report we analyzed several proposals to modify the current tax treatment of health benefits and expenditures. The current tax code will provide about $125.6 billion in tax subsidies for the purchase of health insurance and health services in 2000. While the current tax treatment of health benefits has encouraged employers to offer coverage, it has been criticized as inequitable and a major contributor to health care cost inflation. We examined various tax credit proposals and modifications to the current tax-exemption for health care and estimated the impacts of these proposals on health insurance coverage levels and costs to governments, employers and families.
Client Area: Associations
Expertise Area: Health Reform
July 1998
DHHS, Office of the Assistant Secretaryfor Planning and Evaluation (ASPE)
This report examines the relationships among health insurance, employment, and program participation of people with disabilities. An empirical analysis is conducted of the expansions in the income threshold for the Supplemental Security Income (SSI) work incentive program established by Section 1619 of the Social Security Act. This act allows many working SSI recipients to maintain Medicaid eligibility even after their incomes rise above the level that makes them ineligible for SSI payments. The empirical results indicate that some SSI recipients who work don't earn as much as they could in order to limit their Social Security earnings and stay below the 1619(b) threshold. The numbers and types of disabled people who adjust their earnings vary depending on their age, sex, medical condition, and the income threshold of each state. A separate analysis is also performed using data from the Survey of Income and Program Participation and National Health Interview Survey to generate estimates of the relationships between employment, health insurance, and program participation for a broader population of persons with disabilities. The findings show a large difference in the program participation and employment patterns of persons with less severe disabilities compared to those with severe disabilities.
Client Area: Federal Government
Expertise Area: Health Reform
October 1997
DHHS, Office of the Assistant Secretaryfor Planning and Evaluation (ASPE)
Summary: Health insurance access is an important factor in decisions to work or participate in public programs for single mothers, older workers and the elderly. Many DI and SSI beneficiaries say they are deterred from working for fear of losing their benefits. Recent legislative proposals are designed to address these issues through expanded eligibility for government provided health insurance programs.
Client Area: Federal Government
Expertise Area: Health Reform, Income Security
October 1996
American Hospital Association
Employer health coverage has continued to erode throughout this decade despite the success employers have had in controlling health care costs. Employers responded to the rapid growth in health care costs early in this decade by shifting workers to managed care plans that control costs through price competition and aggressive cost control. However, employers also adopted policies that have led to reductions in the number of covered individuals. For example, some large employers with generous benefits have outsourced many production and service jobs to outside contractors where health insurance is less common and benefits are less comprehensive. Some employers also have discontinued their retiree coverage programs which will ultimately reduce coverage among early retirees. To control costs, employers have also increased employee cost sharing under their health plans and have discontinued coverage for certain specialized services. For example, deductibles and copayments have increased under traditional indemnity plans, partly as an incentive for individuals to shift to managed care alternatives. Coverage for expensive specialty services such as infertility treatments has also declined despite a recent increase in the number of states requiring insurers to cover these services. In addition, employers have increased premium contribution requirements for family coverage, which may be partly responsible for the recent decline in employer coverage among dependents. Some of the reduction in employer coverage will be curtailed by the recently enacted "Health Insurance Portability and Accountability Act of 1996" which requires portability of employer coverage across jobs. However, the impact of this legislation is likely to be negligible since 45 states had already enacted similar legislation by 1995. Thus gaps in employer coverage are likely to continue to be the primary reason for becoming uninsured well into the future.
Client Area: Associations
Expertise Area: Health Reform
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