The best solution for providing near-universal health coverage to uninsured California residents is a state-based system that uses state income tax filing as the primary enrollment and enforcement mechanism, according to a research paper in the current issue of Health Affairs. The proposal, which could be implemented within two years, could extend health coverage to an estimated 85% of uninsured Californians.
The paper was written by George Halvorson, Francis Crosson and Steve Zatkin of the Kaiser Foundation Health Plan. The authors propose increased funding for existing state programs, establishing new programs and finding new revenue sources to provide subsidized coverage for low-income tax filers.
According to the proposal, all residents would have to indicate a defined minimum level of health coverage for themselves and their dependants.
Uninsured tax filers who fall below a defined income level would receive subsidized health coverage under existing public health care programs or enroll in a new state-run plan, CalPrime. Filers who exceed the income level would have several options for obtaining insurance, including purchasing employer-based coverage or enrolling in public programs.
According to the authors, all tax filers would have health insurance, regardless of citizenship status. Residents who do not file taxes would have to enroll voluntarily.
Funding for new and expanded programs would come from new tax revenue sources, safety-net savings, new federal funds and enrollee premiums. The paper also calls for making health care services in California subject to the state sales tax to fund the program and collecting a payroll tax from employers who do not offer coverage to employees (Halvorson et al., Health Affairs, 12/12).
According to accompanying commentary piece by Rick Curtis and Ed Neuschler of the Institute for Health Policy Solutions, the concepts of the proposal by Halvorson and colleagues represent "an important and constructive step toward coverage of the uninsured in states like California."
However, Curtis and Neuschler write that some modifications to the proposal are needed. For example, they are concerned that the subsidy policies would lead to significant state cost overruns. Also, the proposal "omits an important potential means of reducing costs to individual Californians and to the state" through tax savings such as paying for health insurance through payroll deduction, as in Massachusetts.
Curtis and Neuschler's work on health coverage alternatives for California is funded by a California HealthCare Foundation grant (Curtis/Neuschler, Health Affairs, 12/12).
More people with private health insurance who live in rural areas are underinsured compared with people who live in urban areas, a study in Health Affairs found.
Researchers used data from the 2001 and 2002 panels from the Medical Expenditure Panel Survey Household Component.
The study found that:
- 6% of privately insured people living in urban areas were underinsured;
- 10% of privately insured people living in rural adjacent areas were underinsured; and
- 12% of privately insured people living in rural nonadjacent areas were underinsured.
The authors concluded that policymakers should examine out-of-pocket costs associated with prescription drugs for people living in rural areas, a consideration they say might be a significant factor of their underinsurance. Researchers said another cause of the rural population's underinsurance is the design of their private health insurance plans (Ziller et al., Health Affairs, November/December 2006). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.