IHPS provided technical assistance and analysis for California's health reform effort under a multi-year project supported by the California Healthcare Foundation. The Health Affairs papers discussed below are the final product of this endeavor.

Insights for Federal Health Reform From California

Health Affairs web edition articles released March 24, 2009 assess California's recent "shared responsibility" health reform effort and the insights it offers for federal health reform based on a shared responsibility approach. 

The first paper, by IHPS's Rick Curtis and Ed Neuschler, "Affording Shared Responsibility," discusses how California sought to balance the goals of affordability, equity, and cost to the state. It notes how California's approach differed from Massachusetts regarding modest-income workers and related employer and public roles. 

The second paper, by IHPS's Rick Curtis and Ed Neuscher, "Designing Health Insurance Market Constructs," discusses California's approach to providing new, more accessible and efficient ways to obtain coverage for individuals who are not offered employer coverage, including individual-market reforms and choice-pool constructs to achieve
critically important risk spreading, assure solvency and reduce cost shifts.

In addition, a third paper, "The Long And Winding Road," by Marian Mulkey and Mark Smith of the California HealthCare Foundation (which funded IHPS's several years of work on health reform in
California) reflects more broadly on lessons from California's lengthy effort.

All three papers can be accessed here.

Informing the Design of Coverage of California’s Uninsured

The Health Affairs papers discussed above are the final product of a multi-year project under which IHPS provided teechnical assistance and analysis for California's health reform effort. An IHPS-led multi-disciplinary team provided technical assistance and analysis toward the design of workable measures to bring all Californians into health coverage. Supported by sequential grants from the California HealthCare Foundation, this project drew on our earlier work and on input from other experts.

In 2005-2006, we developed, analyzed and issued reports on a range of approaches with varying degrees of responsibility for individuals, employers and the state. We also provided extensive assistance to senior state health officials towards development of the Governor’s proposed coverage plan.

During 2007 and into January 2008, we provided intensive technical assistance and analysis to key health policy staff as the State Assembly and Senate further developed their own respective proposals, and as the legislative and executive branches sought to identify a workable and mutually acceptable coverage package.

A compromise (ABx1-1) between the Governor and the Speaker of the Assembly ultimately failed in the Senate due in large part to a state budget crisis and emerging economic uncertainties. Nevertheless, the shape of the final bill, which IHPS believes was workable, is instructive in many ways. See the “Related Information” box for links to recent presentations and documents on the final bill.

In addition to Rick Curtis and Ed Neuschler of IHPS, the IHPS-led team for this project included Jon Gruber, Health Economics Professor at MIT (cost estimates of alternative proposals), Jim Mays and Cathy Callihan of the Actuarial Research Corporation (actuarial analysis); Pat Butler, J.D. (legal analysis re: ERISA and related issues); Susan Marquis, Senior Economist (emeritus) at RAND (special analyses involving employer group risk and relative cost factors); and John Grgurina (expert consultation to the California Managed Risk Medical Insurance Board and to legislative and executive branch staff to help assure constructs are workable).