This project is to develop and analyze alternative approaches that, by requiring participation in coverage, can cover all Californians while avoiding unnecessary government costs for those who can afford substantial contributions.

With support from the California HealthCare Foundation, an IHPS led team with senior RAND and Actuarial Research Corporation analysts will identify and estimate alternative approaches with varying continuations of individual and/or employer responsibilities.

Consideration will include hybrid approaches that involve individual participation requirements, sliding scale subsidies, and specified minimum employer roles. Each approach will be designed to have internally cohesive coverage elements, including relationship between any health insurance pools or exchanges, public program eligibility policies relating to employer coverage, as well as subsidies for low-income populations.

The project recognizes that as decision-makers develop and consider next-generation approaches to bring the uninsured into coverage, they share several basic concerns. These include: that state costs are within realistic budget constraints; that individuals not be asked to contribute more than they can afford; and that employers not be forced out of business, relocate elsewhere or cut back on jobs or earnings.

For these reasons, the project will estimate state, individual, employer and federal program and tax subsidy spending under the identified alternative approaches.

An IHPS state-based team with RAND and Actuarial Research Corporation team members will design and analyze alternative approaches to cover all residents and require participation in coverage.

Given the project resource constraints, only a few alternative scenarios can be fully estimated. To help ascertain that the approaches analyzed will be of interest to California policy makers, we are consulting with appropriate individuals in specifying policy approaches. One aspect is obtaining input from expert project advisors familiar with related issues and policy interests, and a meeting of such experts was convened on October 12, 2005.

The final report will be designed to inform policy makers of key issues and findings and is scheduled for completion in Spring 2006.