Premium Assistance

Curtis, Richard E.; Neuschler, Edward

doi:10.2307/1602651

Cited by 5 publications

(4 citation statements)

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“…First, difficulties in the employer insurance market will be manifest in any premium assistance program, including the fact that fewer employers are offering health insurance and that the premiums for those who do so are rapidly rising (Shirk and Ryan ). Added to this are particular challenges for the states, including administrative costs and resource requirements, the difficulty of arranging wrap‐around public coverage when the private benefit does not meet state HIFA requirements, and conflicting policies between the employer sponsored insurance (ESI) and the public program (Curtis and Neuschler ). Finally, premium assistance programs pose a new outreach challenge to states, not only to identify and target working families but also their employers.…”

Section: Introductionmentioning

confidence: 99%

The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult  Populations

Atherly

Dowd

Coulam

et al. 2012

Health Services Research

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Research Objective. To evaluate the effect of the Health Insurance Flexibility and Accountability (HIFA) demonstrations on the rate of uninsured. The policy purpose of the HIFA demonstrations is to encourage "new comprehensive state approaches" that will increase the number of insured. HIFA interventions include changes in benefit packages, eligibility rules for public programs, and state subsidization of private health insurance premiums. Some states emphasized private insurance (premium assistance), whereas others placed greater emphasis on expanded eligibility for public insurance. Data Sources/Study Setting. Data were drawn from the Current Population Survey from 2000 to 2007. The target populations for the HIFA waiver demonstrations consisted of individuals who were eligible for the HIFA waiver demonstrations in demonstration states. Study Design. The estimation approach was a probit model using a difference-in-differences approach. Principal Findings. In states that fully implemented their HIFA waiver, HIFA increased the rate of insurance coverage by 6.4 percentage points on average in the targeted adult population, suggesting that approximately 118,848 adults gained health insurance due to HIFA. Total HIFA adult enrollment in the six states studied was 280,739. The effect size varied by state, with Maine having the largest effect and Illinois the smallest. The results were robust to different specifications of the control group. Conclusions. Our findings suggest that public insurance initiatives that provide states with flexibility regarding eligibility and plan design are a viable policy approach to reducing uninsurance rates. Key Words. Under HIFA, states were allowed to subsidize private health insurance premiums for either SCHIP or Medicaid enrollees (the latter under the Medicaid Health Insurance Premium Payment program) (Zabaza 2003). Subsidies for private health insurance premiums were intended to leverage private funds to help cover the uninsured and overcome the "welfare stigma" associated with public insurance programs for low income people. The Centers for Medicare and Medicaid Services (CMS) provided "strong encouragement" to states to further integrate, or at a minimum coordinate, Medicaid and SCHIP funding with private health insurance options (including both group and individual insurance). Flexibility was provided for premium assistance options, in terms of benefits and cost sharing. States also were allowed to use Federal funds to develop and subsidize privately offered health insurance products that groups or individuals might purchase with a public subsidy. A total of fifteen states Table 1). The purpose of our analysis is to determine whether adult enrollment in HIFA programs had the effect of reducing the uninsurance rate in HIFA states. The HIFA programs would reduce the uninsurance rate as long as HIFA enrollees were drawn from the ranks of the previously uninsured rather than from individuals previously enrolled in public or private health insurance programs. Thus, our analysis ...

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Section: Introductionmentioning

confidence: 99%

The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult  Populations

Atherly

Dowd

Coulam

et al. 2012

Health Services Research

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“…See also Mitchell and Osber [10] for more detail on the implementation of the two Massachusetts programs. 2 As part of Massachusetts' recent health care reform, eligibility was expanded to 300 percent of FPL, beginning July 1, 2006. We discuss the implications of this new legislation at the end of this paper.…”

Section: Methodsmentioning

confidence: 99%

“…To receive premium assistance, an individual must have a gross family income less than or equal to 200 percent of FPL, 2 and be employed by a firm participating in the IP. 3 The size of the premium subsidy varies as a function of family income and whether the employee has children.…”

Section: Premium Assistance Program For Employeesmentioning

confidence: 99%

Employer Subsidies for Health Insurance Premiums: Massachusetts' Unique Experiment

Mitchell

Burton²,

Osber³

2009

TOHSPJ

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Efforts to enroll low-income workers in premium assistance programs are constrained by the health insurance offer rates of the firms who employ them. One solution is to target premium subsidies to small firms as well as to their low-income workers, and Massachusetts is the sole state to have tried this. Firms participating in the state's Insurance Partnership were more likely to be self-employed compared with non-participating small firms. Self-employed firms receive a double bonus: assistance payments as both employer and employee. Employer participation in the program has been limited by the low income eligibility threshold and small employer subsidies.

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“…Altogether, 13 states operate such programs, either under HIFA waivers or under other Medicaid/SCHIP provisions (National Conference of State Legislatures 2003). Studies to date generally have focused on the implementation issues associated with these programs rather than the experiences of children and families who enroll in them (see, for example, Curtis and Neuschler 2003;Lutsky and Hill 2003;Mitchell and Osber 2002;Neuschler and Curtis 2003;and U.S. General Accounting Office 1997).…”

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confidence: 99%

What Happens to Children Who Lose Public Health Insurance Coverage?

Mitchell¹,

Haber²,

Hoover

2006

Med Care Res Rev

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Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. While FHIAP-disenrolled children were more likely to have private health-insurance coverage than those leaving SCHIP, absolute levels were low (53 percent and 33 percent, respectively). Thus, these programs generally did not provide a bridge to nonsubsidized private health insurance. Despite higher incomes (the main reason for losing coverage), many families did not purchase private health insurance, presumably because they still could not afford to do so.

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Premium Assistance

Cited by 5 publications

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The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult  Populations

The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult  Populations

Employer Subsidies for Health Insurance Premiums: Massachusetts' Unique Experiment

What Happens to Children Who Lose Public Health Insurance Coverage?

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Premium Assistance

Cited by 5 publications

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The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult Populations

The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult Populations

Employer Subsidies for Health Insurance Premiums: Massachusetts' Unique Experiment

What Happens to Children Who Lose Public Health Insurance Coverage?

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The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult  Populations

The Effect ofHIFA Waiver Expansions on Uninsurance Rates in Adult  Populations