Blueprint for Universal Coverage

The Fund's landmark report, A Blueprint for Universal Health Insurance Coverage in New York, published in December 2006, made a significant contribution to the policy debate around coverage expansion options and associated costs. Continuing Fund work describes progress toward universal coverage—and key outstanding policy issues.  A 2010 update of that report, New York State and the Emerging Federal Health Care Reform Blueprint, examined how key federal health reform issues present important new policy considerations for New York. 

This 2010 "Blueprint Update" maps the progress made toward expanding coverage in New York and the nation since 2006 and highlights key policy considerations New York will face under federal health reform.   Issues explored include those related to insurance market reforms, the development of insurance exchanges, Medicaid expansion, and subsidies to assure affordability.  As the state now works to implement national health reform, the Fund continues to analyze these critical issues, with a particular focus on the insurance exchanges and Medicaid enrollment issues.

A Blueprint for Universal Health Insurance Coverage in New York was the result of the Blueprint for Coverage project established in 2005 by the United Hospital Fund, working jointly with The Commonwealth Fund. The project analyzed distinct and complementary approaches to improving access to public health insurance programs, expanding the scope and reach of those programs to cover more low-income uninsured, and assessed the potential for mandating employer or individual responsibility for health insurance.  Two key components made up the project: modeling of policy options to increase coverage among low-income New Yorkers, and roundtable meetings on key analytic issues underlying policy choices in the expansion of health insurance coverage in New York State.

A related Urban Institute report, Caring for the Uninsured in New York, documents costs of uncompensated care in New York in 2005, and estimates the incremental cost of covering the uninsured—findings consistent with those in A Blueprint for Universal Health Insurance Coverage in New York.

Roundtable Discussions

As both the state and federal government explored options for achieving universal coverage and now work to implement national health reform, the Fund has convened a series of roundtable meetings to discuss policy choices and strategies.  The themes of these meetings, which bring together state and national health policy leaders for frank discussions, have included:

• The Interim High Risk Pool (April 2010), focusing on this first major implementation challenge of the federal health care reform legislation—creating a bridge to coverage for uninsured Americans with chronic conditions, until major market reforms and subsidy provisions take effect in 2014.
• Public Program Simplification (October 2009), addressing the progress to date and challenges still to be met in the simplification of public program enrollment and renewal procedures.
• New York State and Federal Healthcare Reform (July 2009), featuring discussions of how New York could be affected by federal health care reform and the identification of key questions New York will have to answer in the months ahead;
• Public Program Simplification and Expansion (April 2008), featuring discussions on relevant portions of the state's 2007-08 and 2008-09 budget initiatives and state outreach efforts, health plan and provider perspectives on reform implementation, and research findings on simplification reforms and the eligible but uninsured;
• Patterns of Health Care Spending Growth and Strategies for Delivering Effective and Cost-Efficient Care (November 2007), focusing on chronic conditions and “high-cost” Medicaid beneficiaries;
• Choices and Challenges in New York's Health Insurance Market (September 2007), bringing together views from health plan, business, and labor leaders to begin universal coverage discussions;
• Strategies for Universal Coverage: A Blueprint for Coverage in New York (December 2006), including an update on Massachusetts' health care reform;
• State Health Care Reform: Lessons from Massachusetts and Options for New York (June 2006), examining the Massachusetts health care reform plan enacted in Spring 2006, and its relevance to and implications for health care reform in New York;
• Individual Mandates and Program Simplification (December 2005), addressing the potential for an individual mandate and simplification of public insurance programs to expand coverage in New York;
• Options for Increasing Affordability of Coverage Through Public Subsidies (October 2005), featuring presentations on reinsurance, employer buy-ins to public programs, tax credits, and high-deductible health plans and health savings accounts;
• Expanding Employer-Sponsored Coverage: Opportunities and Challenges in Mandated Coverage (January 2005), discussing restrictions on state employer mandates, the potential for an alternative “pay-or-play” policy, other states’ experiences with employer mandates, employer and employee perspectives, and the question of who ultimately bears the costs.