This paper is a summary of a 1999 policy conference, The Kaiser Incremental Health Reform Project, which highlighted both the policy and politics of incrementalism. This paper identifies issues and tradeoffs associated with alternative approaches to expanding health insurance coverage-including enactment and implementation of CHIP and further coverage expansions through public programs and tax credits for the purchase of private health insurance.

Proposals that attempt to expand coverage in the private individual insurance market will only work if private insurance is available and affordable. This paper describes how the current individual marketplace will affect the ability of such proposals to assure equitable access to affordable coverage. This paper is part of the Kaiser Incremental Health Reform Project.

• Issue Paper

This report reviews how states have responded to the $500 million federal fund that was created by the federal welfare reform legislation in 1996 to help states maintain Medicaid coverage for individuals affected by welfare reform. State Medicaid officials were asked whether they have drawn down federal funds from the $500 million fund; to describe the factors that influenced their decision; and what activities they are supporting with the additional federal monies. The paper describes the current status of the $500 million fund and highlights how states are using this new funding.

The Difference Different Approaches Make: Comparing Proposals to Expand Health Insurance

This paper estimates and compares the impacts of alternative mechanisms for expanding health insurance coverage. A variety of approaches-expansions of existing public programs, direct subsidies, and tax credits-and target populations-including children, poor adults, parents of Medicaid- or CHIP-covered children, and early retirees-are considered. The impacts of the proposals on coverage, costs and other program outcomes are compared. This paper is part of the Kaiser Incremental Health Reform Project.

• Report

–

Americans at the end of their working lives are increasingly facing greater uncertainty regarding health insurance and hence access to health care. This paper describes a proposal that would allow older persons not yet eligible for Medicare (under age 65) to “buy into” Medicare coverage.

This paper is part of the Kaiser Incremental Health Reform Project.

• Issue Brief

This paper provides a conceptual analysis of alternative mechanisms (tax credits, public programs, and direct subsidies) for expanding health insurance coverage. The paper, which is part of the Kaiser Incremental Health Reform Project, discusses the likely impacts alternative approaches on a variety of outcomes including efficiency in increasing coverage and integration with existing insurance systems.

• Issue Paper
• Report:

Part of the Kaiser Incremental Health Reform Project, this paper describes a generous tax credit approach to the expansion of health insurance coverage. The design features of refundable, publicly-financed tax credits for the purchase of health insurance are described for a range of sample plans.

• Issue Paper

Many proposals for incremental expansion of health insurance coverage would provide subsidies for the purchase of nongroup policies. This paper assesses how subsidy options might play out in regulated or unregulated markets and explores the possible trade-off between two distinct policy goals: maximizing the absolute number of families with insurance or maximizing access for the highest-risk families. This paper is part of the Kaiser Incremental Health Reform Project.

• Issue Paper

Enactment of the Children’s Health Insurance Program has been accompanied by concerns that new coverage will “crowd out” private health insurance coverage. Part of the Kaiser Incremental Health Reform Project, this paper reviews existing empirical literature on the magnitude of crowd-out and discusses implications for CHIP.

• Issue Paper

This paper examines a method for making health insurance more affordable to people who may lose health insurance when they lose or change jobs. A proposal for subsidizing the purchase of group health insurance through COBRA for employees and their dependents who lose their health insurance coverage when the employee leaves a job that provides such coverage. This paper is part of the Kaise Incremental Health Reform Project.

• Issue Paper