State Strategies for Addressing Uninsured Population

States have employed a variety of strategies to address their uninsured populations. In an effort to expand access to coverage, many states have sought waivers from the Centers for Medicare and Medicaid Services (CMS) to expand their Medicaid and/or SCHIP programs to populations that typically are not eligible to receive benefits. States have also focused on strategies designed to lower the effective price of coverage, either by making reduced-price coverage available or by providing subsidies or incentives for the purchase of private insurance. Other strategies that states have used include reinsurance, high-risk pools, and group purchasing arrangements.

Medicaid and SCHIP Expansions

Medicaid is a jointly funded federal-state program that provides health insurance coverage for low-income individuals. Because of the importance of shared federal financing, Medicaid is often looked to as an integral part of state strategies to expand insurance coverage to the low-income uninsured.

Reinsurance  

States have increasingly looked at reinsurance as a strategy to stabilize health insurance markets and to maintain or increase health insurance coverage. A reinsurance program can be used to reduce premiums by shifting some of the expenses for high-cost enrollees to a third party (e.g., a reinsurance carrier, a reinsurance pool, the state). In addition, reinsurance may lower premiums by reducing the incentive for carriers to hold excess reserves.

High-Risk Pools

A high-risk pool is typically a state-created, nonprofit association that offers comprehensive health insurance benefits to individuals with pre-existing health problems. This could include people who: 1) have been denied coverage in the private market due to a chronic illness (such as cancer or diabetes) or condition; 2) have found they can only access restricted coverage; 3) have a specified (in statute or regulation) high-cost condition; or 4) have been offered a policy that costs more than what is available from the high-risk pool for substantially similar coverage.

Limited-Benefit Plans 

Limited benefit or “bare bones” plans reduce premiums by decreasing the number of covered services in comprehensive health benefits plans. Depending on the state, these types of plans can be referred to as bare bones, mandate-light, mandate-free, limited benefit, minimum benefit, flexible benefit, etc.

Group Purchasing Arrangements

Group purchasing arrangements (GPA) are public or private efforts to allow more than one small/large employer and/or individuals to pool together to collectively purchase health insurance. They seek to achieve lower cost premiums by bringing smaller groups together to achieve the buying power of large groups.

Dependent Coverage

Some states have changed the definition of dependents and extended it beyond the age of 18 for commercial insurance for students and non-students. Policy holders who elect to maintain coverage for adult dependents will pay additional premium. States control the definition of dependent coverage in the commercial insurance market, the state employees' health insurance pool, and other public programs funded by state dollars.