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State efforts on health care could lead to future solutions

With millions of small-business employees still lacking health insurance, policy-makers in the 50 states are trying a wide variety of measures to help employees gain coverage, according to according to
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

 new research recently released by The Nelson A. Rockefeller Institute of Government The Nelson A. Rockefeller Institute of Government is a public policy research institute, or think tank, that conducts studies and other projects relating to state and local government in the United States, American federalism, public management and finance, the implementation of .

Authors of the new research, funded by the New York New York, state, United States
New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of
 State Health Foundation, said studying the efforts under way in all 50 states is critical to finding and spreading solutions to the problems small-business employers and their workers face in attaining affordable health insurance.

The new research is the first nationwide scan of the various measures states are using to address the growing problem of small-group coverage, the Institute noted. In addition to the 50-state research, the Institute released three in-depth case studies on the approaches taken by Maine. Minnesota, and New Jersey.

"States have had some success improving and maintaining access to insurance for small businesses," said Courtney Burke The name Burke (from Irish Gaelic de Burca, of Norman origin). In English the meaning of the name Burke is "fortified hill." See also Berkley. Places
  • Shire of Burke, Queensland, a Local Government Area
, director of the New York Health Policy Research Center at the Rockefeller Institute of Government. "However, we found that most strategies to address small group coverage have been too small in scale to make a large impact on the rate of uninsured. In addition, each strategy used by the states appears to have both benefits and drawbacks.

"States are still struggling to find a comprehensive, highly successful solution to the problem of coverage for small businesses. There may be no single answer, but further experimentation by states and longer-term research on existing reforms may shed further light on this challenging issue."

The research examined the wide range of measures the 50 states are using to address the problem of workers in the small group medical-insurance market, which typically includes businesses with 50 or fewer employees. Problems of both cost and access to coverage are acute in smaller businesses. For example, only 53 percent of firms with 25 or fewer employees offer employment-based medical-insurance benefits - compared to about 80 percent of firms with 500 or more employees.

"Affordability of health insurance to both employees and employers remains a critical challenge for small businesses. That suggests cost-efficiency strategies to slow the growth of health-care costs or otherwise improve affordability should be part of future reform efforts," Burke added.

"Small businesses employ approximately half of New York State's workers. Despite these economic contributions, they face prohibitively pro·hib·i·tive   also pro·hib·i·to·ry
1. Prohibiting; forbidding: took prohibitive measures.

 high health insurance premiums," said New York State Health Foundation president and CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board.  James R. Knickman. "It is critical that the movement to universal coverage in New York State addresses the small group market - we can learn important lessons from other states."

Institute researchers found that while some states are considering comprehensive efforts to expand health-insurance coverage, many incremental Additional or increased growth, bulk, quantity, number, or value; enlarged.

Incremental cost is additional or increased cost of an item or service apart from its actual cost.
 reform strategies have not been widely tested by states - including reducing mandates, extending dependent coverage, and simplifying administration through insurance exchanges.

Strategies used today by the states

The new research found that the states today commonly use three sets of measures to address the problem of small-group coverage: regulation of supply, pooling and administrative simplification, and subsidies. Of the three, all 50 states use some form of regulation of supply, especially guaranteed issue and portability. Guaranteed-issue regulations require that insurers issue policies to all members of the small-group market. Portability requires that employees of small businesses be able to access health insurance when they switch jobs.

In the pooling and administrative-simplification category, used by about a dozen states, the most popular measures involved group purchasing arrangements and dependent coverage. Group purchasing allows employers to come together in a pool to buy health insurance, typically at a lower cost. Dependent coverage allows younger dependents to remain on their parents' insurance longer, such as until 25 years of age.

Finally, at least eight states are using various subsidies to enhance small group coverage, including premium subsidies to make insurance more affordable, refundable Refundable

Eligible for refunding under the terms of a bond indenture.
 tax credits, and reinsurance The contract made between an insurance company and a third party to protect the insurance company from losses. The contract provides for the third party to pay for the loss sustained by the insurance company when the company makes a payment on the original contract.  - a type of insurance product that protects against the risk of financial losses from high-cost medical cases.

The Institute's researchers found that most affordability measures, such as reducing insurance costs or providing subsidies for purchasing insurance, are limited in scope and inadequately evaluated to determine their effectiveness.

The research also closely examined the approaches utilized by Maine, Minnesota, and New Jersey. Field research from those three states is designed to help policymakers better understand what they must consider to successfully implement, administer, and finance reform initiatives. Certain administrative and implementation methods - such as inclusive reform and governance Governance makes decisions that define expectations, grant power, or verify performance. It consists either of a separate process or of a specific part of management or leadership processes. Sometimes people set up a government to administer these processes and systems. , flexibility in modifying reform approaches, attention to program design details, and sustainable funding - were essential to success.

Thomas L. Gais, co-director of the Rockefeller Institute, commented on the research, saying, This research, including the 50-state scan, as well as the three case studies, shows that some states have taken complex, multi-pronged approaches to expanding health insurance coverage in small groups. The research also makes clear especially in the case studies - that reform never ends. Governments need to adjust their policies and administrative efforts to ever-changing circumstances CIRCUMSTANCES, evidence. The particulars which accompany a fact.
     2. The facts proved are either possible or impossible, ordinary and probable, or extraordinary and improbable, recent or ancient; they may have happened near us, or afar off; they are public or
 and unexpected developments, and track their performance in helping small groups."

The Nelson A. Rockefeller Institute of Government, the public-policy research arm of the State University of New York (body) State University of New York - (SUNY) The public university system of New York State, USA, with campuses throughout the state. , conducts fiscal and programmatic pro·gram·mat·ic  
1. Of, relating to, or having a program.

2. Following an overall plan or schedule: a step-by-step, programmatic approach to problem solving.

 research on American state and local governments.

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Publication:Business Journal - Central New York, The
Date:Nov 14, 2008
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