Prometheus 6   

Mainstreaming Low-Income Health Insurance Programs

New Dem Play | Make low-income health insurance coverage available through employers
Where It's Working | Idaho, Massachusetts, and other states
Players | State officials

Low-income workers frequently have trouble getting health insurance coverage through the public programs technically available to them. The problem is that public health insurance programs for low-income workers and their families are separate from the system of job-based coverage used by most workers. In effect, this separation is a barrier because it means low-income workers must first hear about the opportunity to get coverage through a public program and then they must sign up, typically by going through a welfare agency. That requirement penalizes workers who cannot get time off from work to visit the welfare office and adds the stigma of welfare in the eyes of many workers. In contrast, workers who have job-based insurance conveniently sign up when they do their employment paperwork and then easily remain covered, since their employer pays their insurance premium.

The rates of insurance coverage among the working poor illustrate most clearly the problem with two separate systems. While very few workers with job-based coverage remain without insurance, nearly 20 percent of children eligible for the federal SCHIP (State Child Health Insurance Program) or Medicaid coverage are not enrolled. That low participation rate leaves nearly five million kids uninsured.

In order to remove barriers to health insurance coverage, state policymakers should mainstream coverage for low-income workers by making it available through their jobs. One strategy is to use the worksite to enroll people in public programs when an employer doesn't offer coverage [p6: actually, not a bad concept]. Another is to use Medicaid and SCHIP funds to pay for job-based coverage when it is available. Several states offer policymakers examples of how this second strategy works in practice.