Health Affairs

Posting date: June 7, 2005

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Health Affairs, 10.1377/hlthaff.w5.259
Copyright © 2005 by Project HOPE

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Variations In The Impact Of Health Coverage Expansion Proposals Across States

Sherry Glied ^1* Douglas Gould ²

¹ Sherry Glied is a professor of health policy and management and department chair, Mailman School of Public Health, Columbia University, in New York City.
² Douglas Gould is a senior programmer, Mailman School of Public Health.

^*Corresponding author.

Abstract

Most estimates of the consequences of alternative health insurance proposals focus on national impact, but the extent of cross-state diversity in uninsurance rates, economic and labor-market characteristics, and health care markets suggests that the impact of strategies will also vary. We illustrate this variation by comparing the effects of standard tax credit and Medicaid expansion proposals across states. Some states do well (or poorly) under all policies; others benefit under some but not others. Across policies, state effects on uninsurance rates vary by at least a factor of 2.5. Uniform national strategies that target the uninsured do not generate uniform national outcomes.

Key Words: Access To Care, Consumer Issues, Health Reform, Insurance Coverage, State/Local Issues, Health Spending, Variations, Insurance Market

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