This report, released by the Center for Rural Affairs and the Center for Community Change, highlights the unique challenges of rural health care.  The report notes that rural communities have a lower rate of employer-sponsored insurance because rural economies rely more heavily on small businesses and self-employment.  The report also finds that rural areas have twice the rate of underinsurance as urban areas and that rural residents pay 22 percent more for health coverage than those living near metropolitan areas.

Full Report: http://www.communitychange.org/library/CCC-sweet-hivfin.pdf/idea_view 

Center for Rural Affairs and Center for Community Change. (2009). Sweet the bitter drought why rural America needs health care reform. Jon Bailey, Sally Kohn & Angie Evans

This Migration Policy Institute (MPI) report finds that current health care reform proposals do little to help immigrants, including legal permanent residents.  MPI finds that 4.2 million of the 12 million legal immigrants in the U.S. are currently uninsured and notes that many are temporarily barred from state Medicaid programs because of a 1996 law requiring that legal aliens wait five years from the date they obtain their green card before becoming eligible for Medicaid.  The report finds that maintaining that restriction and applying it to the government health insurance subsidies for individuals earning up to 400 percent of the federal poverty level (FPL) will limit health insurance access for over 1 million legal immigrants.  In addition, the report examines the cost implications of limiting health insurance access for both legal and illegal immigrants under various health reform proposals. 

Full Report: http://www.migrationpolicy.org/pubs/healthcare-Oct09.pdf 

Migration Policy Institute. (2009). Immigrants and health care reform what's really at stake? Randy Capps, Marc R. Rosenblum, Michael Fix.

This Commonwealth Fund report presents the results of the 2009 State Scorecard on Health System Performance , assessing states’ performance in health care access, quality, cost, and outcomes.  The report found that states’ performance continues to vary widely; however, all states face rising health care costs and poor care coordination.  The report notes that Vermont, Hawaii, Iowa, Minnesota, Maine, New Hampshire, Massachusetts, Connecticut, North Dakota, Wisconsin, Rhode Island, South Dakota, and Nebraska were the overall highest performers; however, the scorecard does not yet reflect the effects of the recession because of a reporting lag. 

From the report:

Focused on identifying opportunities to improve, The Commonwealth Fund’s State Scorecard on Health System Performance assesses states’ performance on health care relative to achievable benchmarks for 38 indicators of access, quality, costs, and health outcomes. The 2009 State Scorecard paints a picture of health care systems under stress, with deteriorating health insurance coverage for adults and rising health care costs. On a positive note, there were gains in children’s coverage as a result of national reforms, and improvement in some measures of hospital and nursing home care following federal efforts to publicly report quality data. The scorecard highlights persistent wide variation in performance across states and continued evidence of poor care coordination. Increasing cost pressures and deterioration in access across the U.S., together with geographic disparities in performance, underscore the urgent need for comprehensive national reforms to ensure access, change the trajectory of costs, and enhance value.

Full report: http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2009/Oct/1326_McCarthy_state_scorecard_2009_full_report_FINAL.pdf 

The Commonwealth Fund. (2009). Aiming higher: results from a state scorecard on health System performance, 2009. Douglas McCarthy, Sabrina K. H. How, Cathy Schoen, Joel C. Cantor, and Dina Belloff.

A new fact sheet published by the UCLA Center for Health Policy Research finds that 93 percent of Californians under 65 would have access to health coverage if Congress passes a national health reform bill.  Four million state residents would be eligible for Medi-Cal or would qualify for subsidies to purchase private insurance.

From the document:

If leading proposals in Congress for national health care reform are enacted, most of California’s 6.4 million nonelderly adults and children who were uninsured for all or part of the year in 2007 would directly benefit. The three major proposals in both the House and Senate all would make two key changes: 1) they will expand Medicaid eligibility to include qualified uninsured adults and children with household incomes up to 133% of the Federal Poverty Level (FPL); and 2) they will provide public subsidies to enable qualified uninsured adults and children with household incomes from 134 – 400% FPL to purchase insurance.1 An estimated four million Californians would be newly eligible either for public health insurance (in Medi-Cal, California’s Medicaid program) or for public subsidies to purchase private coverage.

UCLA Center for Health Policy Research. (2009). National Health Care Reform Will Help Four Million Uninsured Adults and Children in California. Lavarreda, Shana & Brown, E. Richard.

Fact sheet: http://www.healthpolicy.ucla.edu/pubs/files/HCR_FS_10-09.pdf

This Center on Budget Policies and Priorities (CBPP) report states that the structure of the health insurance premium subsidies provided under the Senate Finance Committee’s version of health care reform would be insufficient for many Americans.  The report notes that, though the subsidies would limit premium expenses for low-income residents based on their income during the first year of implementation, future premium caps would be based on a percentage of the first-year premiums rather than on income.  The CBPP report notes that, because health care premiums have risen significantly faster than incomes, premiums for those receiving the subsidy could easily exceed the original caps.

From the report:

Consider an illustrative family of three in which the father earns $35,000 from a small retailer and the mother earns $11,000 as a part-time sales clerk. Neither receives health care through his or her employer. The couple has a daughter in elementary school. The couple has avoided accruing credit card debt but has no life insurance or retirement savings. After paying basic expenses,4 this family has about $650 a month to cover costs for clothes, car repairs and maintenance, various other household expenses, restaurant meals, and any hobbies or activities — as well as the family’s health care expenses. Under the Finance Committee bill, this family could pay $360 — 55 percent of the remaining monthly amount — to cover the cost of premiums. In comparison, under the Senate HELP bill, this family would pay $214, or 33 percent of its remaining monthly budget, for premiums. Under the House bill, the family would pay monthly premiums of about $305, or 47 percent of its remaining monthly income.

Center on Budget and Policy Priorities. (2009). Finance committee health reform bill makes improvements but still falls short of what is needed for many people to afford health care.  Angeles, January & Solomon, Judith.

Full report:  http://www.cbpp.org/files/10-13-09health.pdf

This Urban Institute brief examines the effects of age rating rules under different versions of congressional health care reform.  It uses Health Insurance Policy Simulation Model (HIPSM) to compare the financial implications of the differing age rating ratios (5:1, 2:1, and 1:1) which would control the price disparity between older and younger adults’ premiums.

From the summary:

The authors find that there is little difference in overall health insurance coverage or aggregate spending under reform, regardless of the premium rating option chosen. However, practical affordability of total health care costs (premiums and out-of-pocket expenses) will be strongly related to premium rating rules for those individuals and families with incomes too high to qualify for federal subsidies, particularly those with incomes between 400 and 500 percent of the federal poverty level. For many older adults and older families, the higher out-of-pocket costs that come with greater medical use in older age, combined with high premiums due to steep age rating (such as 5:1 bands), would lead to a high burden of total health care costs relative to income.

The Urban Institute.  (2009). Timely analysis of immediate health policy issues. Blumberg, Linda,  Buettgens, Matthew & Garrett, Bowen.

Full report: http://www.urban.org/UploadedPDF/411970_age_rating.pdf