The National Academies
Institute of Medicine
Fostering Rapid Advances in Health Care: Learning from System Demonstrations
State Health Insurance: Making Affordable Coverage Available to All
Americans
Demonstration projects in this category are intended to result in the availability of affordable insurance coverage to all Americans in a state.
Coverage expansions – Demonstration projects might expand insurance coverage
through either tax credits to be applied to an insurance plan, expanded eligibility for public insurance programs, or a combination of the two. Under the tax credit approach, the federal government would provide support to a demonstration site to be used for premium assistance, and the state would provide state tax credits to uninsured individuals. The state tax credit would likely be based on a sliding scale tied to income, and would need to be adequate to enable the individual to purchase a good insurance package. Under the approach of expanded eligibility for public insurance programs, the federal government would provide federal matching support for a significantly expanded eligibility program under a state Medicaid or SCHIP program.
http://books.nap.edu/books/0309087074/html/R1.html
Comment: Health and Human Services Secretary Tommy Thompson requested the Institute of Medicine to prepare a report on demonstration projects that would find ways to fix our health care delivery system, a system that is unable to meet current and future needs. It is probably no coincidence that the demonstration projects, including expansion of community health centers, and introduction of tax credits to purchase private health plans, reflect the policies already publicly supported by the Bush administration.
Recent reports have demonstrated the deficiencies of relying on community health centers, especially in their inability to provide access to adequate
specialized services, or even access to prescription drugs. And tax credits
primarily support the individual insurance market, noted for its higher costs, fewer benefits, excessive cost sharing, and especially for its underwriting practices that exclude those with the greatest health care needs. If a state were to establish a pilot project, certainly it should have the option of establishing a single insurance program that provides comprehensive services for everyone, made possible by eliminating the administrative excesses of the private insurance market.
By issuing a report that is designed to support the credibility of the Bush administration’s highly inadequate and grossly flawed health policies, The Institute of Medicine has severely tarnished its own credibility.