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"Premium Assistance" means helping low-income working families to pay the employee contribution necessary to enroll (or remain enrolled) in employer-sponsored coverage that is available to them.
Many policy makers see premium assistance as a cost-effective way to extend coverage to uninsured working families, for reasons that include the following:
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By taking advantage of available employer contributions, premium assistance allows states to serve more uninsured children and families with the public funds available.
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When eligibility for public programs expands above the poverty level, using premium assistance discourages such workers from shifting from employer-financed coverage to public coverage.
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Assisting families to enroll together conveniently in a single health plan often makes it more likely that children will be covered and will actually use preventive services and other necessary medical care.
Because employment-based health benefits can help to strengthen modest-income parents' attachment to the labor force, many states believe premium assistance is consistent with the welfare reform goal of encouraging self-sufficiency through employment. Some states also find that, by offering alternative assistance for mainstream coverage venues, premium assistance can reach uninsured children whose parents are reluctant to enroll them directly in a separate public program.
But states seeking to develop and implement premium assistance programs have faced significant challenges that arise from federal requirements, from the difference between public program and employer structure, and from other practical operational issues. As a result, only a few have achieved significant premium assistance enrollment to date. Where the goal is broad coverage of the uninsured involves very large enrollments in premium assistance, states should consider alternative structures to greatly streamline the process.
Since 1996, the Institute has carried out several projects and provided analysis and assistance to states (and, in some cases, localities) interested in developing premium assistance programs. Our reports (below) address the wide variety of policy, mechanical and operational issues surrounding premium assistance.
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Premium Assistance in a Broad Coverage Reform Environment
An Implementation and Alternative Scenario Analysis of California's Health Insurance Act of 2003(SB2) (IHPS 2005)For specific information on Premium Assistance, see "Full Report" of this paper, pages 55-57, Sections 3.5.2 and 3.5.3.
Premium Assistance — Overview
Premium Assistance: What Works? What Doesn't? (IHPS, April 2003)
Premium Assistance (Future of Children, Volume 13, Number 1, published by the Center for the Future of Children Spring, 2003)
Purchasing Private Health Insurance through Government Healthcare Programs: A Guide for States (IHPS, June 1999)
Treatment of Flexible Benefit Plans Under Employer Coverage Subsidy Programs (IHPS, November 1998)
Employer Coverage and the Children's Health Insurance Program Under the Balanced Budget Act of 1997: Options for States (IHPS, December 1997)
Extending Health Care Coverage for Modest-Income Children and Pregnant Women: Public & Employer Financed Coverage Lessons (IHPS, December 1996)
Health Care Financing Reform to Cover the Uninsured: A Guide to Joint Public and Private Financing Strategies (IHPS, December 1992)
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Premium Assistance through Purchasing Pools
Potential Tasks for Implementing Premium Assistance through a Consumer Choice Health Purchasing Group (IHPS, May 2000)
Coordination of Title XXI Coverage with Employer-Based Coverage through Consumer-Choice Health Purchasing Groups (IHPS, January 1999)
Case Studies
Overview of the Iowa Health Insurance Premium Payment (HIPP) Program (IHPS, Feb 2000)
MassHealth Family Assistance Program: A Case Study of an Employer-Based Insurance Subsidy Program (IHPS, June 1999)
An Overview of the Oregon Family Health Insurance Program (IHPS, December 1998)
MinnesotaCare and "Crowding-Out" (IHPS, September 1998)
Special Enrollment Periods (IHPS, January 1998)
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Under S-CHIP
Coordinating Children's Health Insurance Programs with Employment-Based Coverage: Design and Implementation of Premium Assistance Programs (IHPS, October 1999)
Subsidizing Employer-Sponsored Insurance Under State Children's Health Insurance Programs: Working with a Supplemental Carrier (IHPS, October 1999)
Subsidy Payment Structure Alternatives (for Coordinating with Employer Coverage Under CHIP) (IHPS, May 1999)
Supplementing Cost-Sharing Provisions of Employer-Based Insurance Plans (IHPS, February 1999)
Likelihood of Exceeding Family Cost Sharing Limits (IHPS, December 1998)
Children and Employer-Based Coverage: The Data (IHPS, October 1998)
Benefits and Cost-Sharing: Meeting CHIP Rules When Subsidizing Employer-Sponsored Plans (IHPS, August 1998)
Meeting Cost-Sharing Requirements Under CHIP Premium Subsidy Programs (IHPS, July 1998)
Coordinating Children's Coverage Expansions with Employer Sponsored Insurance (IHPS, March 1998)
Alternative Approaches for Paying Child Health Insurance Subsidies (IHPS, January 1998)
Employer Coverage and the Children's Health Insurance Program Under the Balanced Budget Act of 1997: Options for States (IHPS, December 1997)
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Public Programs & "Crowd-Out" of Employer Coverage
Medicaid and Child Health Crowding Out: Synopsis of Resources (IHPS, December 1998)
MinnesotaCare and "Crowding-Out" (IHPS, September 1998)
Finding Practical Solutions to 'Crowding Out' (IHPS, January 1997)
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