Group Health Insurance Coverage

Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million--one in seven--working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive worse care when they are in the hospital, even for acute situations like a motor vehicle crash.

With the collapse of national health care reform efforts in the early 1990s, states emerged as a focal point for new policy and administrative developments in U.S. health care. This book provides a timely overview of the key issues facing states as they have responded to this challenge. It tells how states are making decisions about health policies and then putting them into action -- and how legislatures, executives, courts, and bureaucracies all participate in this process. The New Politics of State Health Policy describes many of the major trends in states' responses to health care problems of the 1990s, and it identifies the forces that will influence state policy actions in the new century. It examines reforms now under way, from Medicaid to tobacco control to mental health, and addresses today's most pressing issues surrounding managed care, health insurance, and public health administration. Editors Hackey and Rochefort have brought together a distinguished group of scholars and practitioners in the field of health policy analysis. Frank Thompson, Theodore Marmor, Michael Dukakis, and others map out the different institutional frames shaping how each state approaches the health care domain. While some states deliberate over universal coverage, others have shifted to the county level decisions once made in Washington, D.C. But all face the difficulty of taking on unprecedented responsibilities with limited resources amid the often-conflicting concerns of public management and "moral politics". Each contribution in the volume explores the interplay between state governance and health care policy by addressing four themes: the capacity of states to fulfill their new healthcare roles, the significance of recent policy changes, patterns in the politics of state health policy making, and the relationship of state-level changes to failed national health care reform.