HCFO: grant findings

Changes in Health Care Financing & Organization

Do State Parity Laws Reduce the Financial Burden on Families of Children with Mental Health Care Needs?
Susan H. Busch, Ph.D.

Susan H. Busch, Ph.D., associate professor in the Department of Epidemiology and Public Health at the Yale University School of Medicine, co-authored an article titled, "Do State Parity Laws Reduce the Financial Burden on Families of Children with Mental Health Care Needs?" that appeared in the June 2007 issue of the Health Services Research. The article describes HCFO-sponsored research examining the financial impact of state parity laws on families of children requiring mental health services.

Geographic Variation in Alcohol, Drug, and Mental Health Services Utilization: What are the Sources of the Variation?
Mark Edlund, M.D., Ph.D.

Mark Edlund, M.D., Ph.D., assistant professor of Psychiatry at the University of Arkansas for Medical Sciences, and Thomas Belin, Ph.D., professor of Biostatistics at the UCLA School of Public Health, co-authored an article titled, "Geographic Variation in Alcohol, Drug, and Mental Health Services Utilization: What are the Sources of the Variation?" that appeared in the September 2006 issue of the Journal of Mental Health Policy and Economics. The article describes HCFO-sponsored research examining the extent to which geographic variation in assessment and treatment rates for alcohol, drug, and mental disorders (ADM) was due to variation in case-mix across sites and to quantify the amount of geographic variation after case-mix adjustment.

Current HCFO grantee publications and recent grant findings will be regularly featured in the results section of our Web site.

Revisiting the Relationship between Managed Care and Hospital Consolidation
Robert J. Town, Ph.D.

Robert J. Town, Ph.D., professor in the department of Health Services Research and Policy at the University of Minnesota, is the co-author of an article titled, "Revisiting the Relationship between Managed Care and Hospital Consolidation," that appeared in an early online issue of HSR. The article describes HCFO-sponsored research examining whether the rise in managed care during the 1990s caused the increase in hospital concentration.

"Adequacy of Household Survey Data for Evaluating the Nongroup Health Insurance Market "
Joel C. Cantor, Sc.D.

Joel C. Cantor, Sc.D., professor and director, Center for State Health Policy, Rutgers University, is the co-author of an article titled, " The Adequacy of Household Survey Data for Evaluating the Nongroup Health Insurance Market " that appeared in an early online issue of HSR. The article describes HCFO-sponsored research examining the accuracy of household survey estimates of the size and composition of the population covered by nongroup insurance.

"Do State Parity Laws Reduce the Financial Burden on Families of Children with Mental Health Care Needs?"

Susan H. Busch, Ph.D.

Susan H. Busch, Ph.D., associate professor with the Department of Epidemiology and Public Health, Yale University School of Medicine, is the co-author of an article titled, "Do State Parity Laws Reduce the Financial Burden on Families of Children with Mental Health Care Needs?" that appeared in an early online issue of HSR. The article describes HCFO-sponsored research examining the financial impact of state parity laws on families of children in need of mental health services.

Tort Law and Medical Malpractice Insurance Premiums
Michael A. Morrisey, Ph.D.

Michael A. Morrisey, Ph.D., professor in the Department of Health Care Organization and Policy, Lister Hill Center for Health Policy, University of Alabama at Birmingham, is a co-author of an article that appeared in the Fall 2006 issue of Inquiry, titled "Tort Law and Medical Malpractice Insurance Premiums." The article describes HCFO funded research on the effects of tort law and insurer investment returns on physician malpractice insurance premiums.

Economic Profiling of Physician Specialists: Use of Outlier Treatment and Episode Attribution Rules
J. William Thomas, Ph.D.

J. William Thomas, Ph.D., professor at the Institute for Health Policy, Edmund S. Muskie School of Public Service, University of Southern Maine, is a co-author of an article that also appeared in the Fall 2006 issue of Inquiry. Titled "Economic Profiling of Physician Specialists: Use of Outlier Treatment and Episode Attribution Rules," the article examines HCFO funded research on the influence of episode attribution methodology and cost outlier methodology on the accuracy of physicians' economic profiles.

False Hope: Bone Marrow Transplantation for Breast Cancer
Richard A., Rettig, Ph.D., Peter D. Jacobson, J.D., M.P.H, Cynthia Farquhar, M.D., and Wade Aubry, M.D.,

Richard A., Rettig, Ph.D., Peter D. Jacobson, J.D., M.P.H, Cynthia Farquhar, M.D., and Wade Aubry, M.D., will release their new book, False Hope: Bone Marrow Transplantation for Breast Cancer, in December 2006. The book “tells of the rise and demise of HDC/ABMT for metastatic and early stage breast cancer, and fully explores the story's implications, which go well beyond the immediate procedure, and beyond breast cancer, to how we in the United States evaluate other medical procedures, especially life-saving ones.”

Defective Design: Regional Competition in Medicare
Steven D. Pizer, Ph.D.

Steven D. Pizer, Ph.D., a health economist at the Veterans Affairs (VA) Boston Health Care System and assistant professor of health services at the Boston University School of Public Health, is the co-author of an article that appeared in the August 23, 2005 Web Exclusive issue of Health Affairs, titled "Defective Design: Regional Competition in Medicare." The article details HCFO-sponsored research, which examined the competitive bidding process in Medicare Advantage under the Medicare Modernization Act of 2003.

The Balanced Budget Act of 1997 and U.S. Hospital Operations
Gloria J. Bazzoli, Ph.D.

Gloria J. Bazzoli, Ph.D., a professor in the Department of Health Administration at Virginia Commonwealth University, is a co-author of an article released in the Winter 2004/2005 issue of Inquiry, titled "The Balanced Budget Act of 1997 and U.S. Hospital Operations." The article details HCFO sponsored research examining how changes to hospital payments made in the BBA affected hospital operations and comparing these effects to those that occurred with implementation of the Medicare prospective payment system in the early 1980s.

Employer Health Insurance Offerings and Employer Enrollment Decisions
Daniel Polsky, Ph.D.

Daniel Polsky, Ph.D. a research associate professor in the Division of Internal Medicine at the University of Pennsylvania, is a co-author of an article released in the October 2005 Part I issue of HSR titled "Employer Health Insurance Offerings and Employer Enrollment Decisions." The article details how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions.

Medicaid Managed Care and Health Care for Children
Laurence Baker, Ph.D.

Laurence Baker, Ph.D., a professor at the Department of Health Research and Policy, at Stanford University, is the co-author of an article featured in the October 2005 Part I issue of HSR titled "Medicaid Managed Care and Health Care for Children." The article details the relationship between Medicaid managed care enrollment and health care for children.

The Effects of Price Competition and Reduced Subsidies for Uncompensated Care on Hospital Mortality
Kevin G.M. Volpp, M.D., Ph.D.

Kevin G.M. Volpp, M.D., Ph.D., a professor at University of Pennsylvania School of Medicine and The Wharton School, is a co-author of an article published in the August 2005 issue of HSR titled "The Effects of Price Competition and Reduced Subsidies for Uncompensated Care on Hospital Mortality." The article details the impact on hospital mortality rates in New Jersey after the implementation of a law that changed hospital payment from a regulated system based on hospital cost to a price competition model that reduced subsidies for uncompensated care. The article also looks at whether changes in mortality rates were affected by hospital market conditions.

Rules for Medical Markets: The Impact of Medicare Contractors on Coverage Policies
Susan Bartlett Foote, J.D., M.A.

Susan Bartlett Foote, J.D., M.A., an associate professor in the Division of Health Services Research and Policy at the University of Minnesota, is the co-author of an article that appears as an online early publication, and will be published in HSR, titled "Rules for Medical Markets: The Impact of Medicare Contractors on Coverage Policies." The article details HCFO sponsored research examining Medicare's local contractors' role in medical markets and nationally consistent payment rules.

Should Episode-Based Economic Profiles Be Risk Adjusted to Account for Differences in Patients' Health Risks?
J. William Thomas, Ph.D.

J. William Thomas, Ph.D., a professor at the Institute for Health Policy at the Edward J. Muskie School of Public Service, University of Southern Maine, is the author of an article that appeared in the April 2006 issue of HSR, titled "Should Episode-Based Economic Profiles Be Risk Adjusted to Account for Differences in Patients' Health Risks?". The article details HCFO sponsored research examining the effect of risk-adjustment on cost efficiency rankings of physicians.

Reinsuring Health: Why More Middle-Class People Are Uninsured and What Government Can Do
Katherine Swartz, Ph.D.

Katherine Swartz, Ph.D., an associate professor of health policy and management at the Harvard School of Public Health, has recently released a book, published by the Russell Sage Foundation, titled Reinsuring Health: Why More Middle-Class People Are Uninsured and What Government Can Do. The book "examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans."

The Influence of Health Policy and Market Factors on the Hospital Safety Net
Gloria Bazzoli, Ph.D.

Gloria Bazzoli, Ph.D., a professor of Health Administration at Virginia Commonwealth University, is the co-author of an article that appeared in the March 2006 issue of HSR, titled "The Influence of Health Policy and Market Factors on the Hospital Safety Net". The article details HCFO sponsored research examining the effect of the Balance Budget Act of 1997 on the hospital safety net.

Will Choice-Based Reform Work for Medicare? Evidence from the Federal Employees Health Benefits Program
Curtis Florence, Ph.D.

Curtis Florence, Ph.D., an assistant professor in the Department of Health Policy and Management at the Rollins School of Public Health at Emory University, is the co-author of an article that appeared in an early-online publication of HSR, titled "Will Choice-Based Reform Work for Medicare? Evidence from the Federal Employees Health Benefits Program". The article details HCFO sponsored research examining the effect of premiums and benefits on the health plan choices of older enrollees who choose Federal Employees Health Benefits Program (FEHBP) health plans as their primary payer.

The Effect of Market Reform on Racial Differences in Hospital Mortality
Kevin Volpp, M.D.

Kevin Volpp, M.D., assistant professor of medicine and an assistant professor of health care systems at the Wharton School at the University of Pennsylvania, is the co-author of an article that appeared in an early-online publication of JGIM titled, "The Effect of Market Reform on Racial Differences in Hospital Mortality." The article details HCFO sponsored research examining the effect of a 1993 New Jersey law that reduced subsidies for uninsured hospital care and changed hospital payment from rate regulation to price competition on racial differences in hospital mortality.

Prescription Drug Spending for Medicare+Choice Beneficiaries in the Last Year of Life
Jon Gabel

Jon Gabel, vice president of the Center for Studying Health System Change, is the co-author of an article that appeared in the August 2006 issue of the Journal of Palliative Medicine titled, "Prescription Drug Spending for Medicare+Choice Beneficiaries in the Last Year of Life." The article describes HCFO-sponsored research examining ways prescription drug costs at the end of life and may help clinicians navigate Medicare Part D coverage for chronically ill individuals.

Treatment of Coronary Artery Disease:
What Does Rationing Do?
Henry J. Aaron, Ph.D.
HCFO researcher Henry J. Aaron, Ph.D., Brookings Institution, recently completed a policy brief titled "Treatment of Coronary Artery Disease: What Does Rationing Do?" The brief was prepared as part of Aaron's larger HCFO-funded project under which he authored "Can We Say No? The Challenge of Rationing Health Care."

Welfare Reform, Insurance Coverage Pre-Pregnancy, and Timely Enrollment: An Eight-State Study
E. Kathleen Adams, Ph.D.
This article details HCFO-sponsored research, which examined the implementation of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), which altered the relationship between Medicaid eligibility/enrollment and welfare cash assistance for women eligible at welfare income levels.

Please note: The use or printing of this electronic file of an article appearing in Inquiry is limited to individual, non-commercial use. Copying or reusing the content of this material, without the expressed, written consent of Inquiry is prohibited. You may contact Inquiry through our Web site www.inquiryjournal.org or by e-mail at inquiry@hartleydata.com. Copyright 2004 Excellus Health Plan, Inc. The opinions expressed by any of Inquiry's authors do not necessarily reflect the position of Excellus Health Plan, Inc.

Has Competition Lowered Hospital Prices?
Jack Zwanziger, Cathleen Mooney
This paper examines hospital deregulation in New York and the effect of competition and consolidation on hospital prices.

Employer Health Insurance Offeringsand Employee Enrollment Decisions
Daniel Polsky, Rebecca Stein, Sean Nicholson,
and M. Kate Bundorf
This paper assesses how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions. The researchers found that when an employer offers only a health maintenance organization, married employees are more likely to decline coverage from their employer and take-up another offer, but single individuals are more likely to accept the coverage offered by their employer and less likely to be uninsured.

Medicaid Managed Care and Health Care for Children
Laurence C. Baker and Christopher Afendulis
This paper examines the relationship between Medicaid managed care enrollment and health care for children.

Risk Selection in Employer-Sponsored Managed Care Plans
Monica Marchetta

In a recent HCFO-sponsored research project, Daniel Polsky, Ph.D., and colleagues at the University of Pennsylvania sought to determine whether, on a national level, lower premiums for health maintenance organizations (HMOs) could be attributed to healthier enrollees. Their findings suggest that lower premiums are only partially a result of risk selection. Dr. Polsky and his colleagues further report that these lower premiums do not necessarily suggest that managed care is a more efficient model of health care delivery.

The Effects of Price Competition and Reduced Subsidies for Uncompensated Care on Hospital Mortality
Kevin G. M. Volpp, Jonathan D. Ketcham, Andrew J. Epstein, Sankey V. Williams

This paper examines whether hospital mortality rates changed in New Jersey after implementation of a law that transformed hospital payment and if changes in mortality rates were affected by hospital market conditions.

State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit
Claudia Williams, Sarah Goodell, Jack Hoadley, Ellen O’Brien, and Matt Kanter

This policy brief is one in a series presenting results from a recent study of State Pharmacy Assistance Programs (SPAPs), their implementation experience and responses to the new Medicare drug benefit. The study included site visits, in-depth interviews with state program leaders and stakeholders and a questionnaire of state program directors to explore their plans and preferences for responding to the Medicare drug benefit. The Principal Investigator for the study is Jack Hoadley. The study was funded by The Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative, for which AcademyHealth serves as the National Program Office.

Assessing The Impact Of Coverage Gaps In The Medicare Part D Drug Benefit
Bruce Stuart, Linda Simoni-Wastila, and Danielle Chauncey

To help policymakers understand the implications of the design of the new Medicare Part D drug benefit, this paper examines a representative sample of Medicare beneficiaries with naturally occurring prescription benefit gaps between 1998 and 2000 using data from the Medicare Current Beneficiary Survey.

"Variation in Medicare's Local Spending
Policies: Content Analysis of Local
Medical Review Policies
Susan Bartlett Foote, Rachel Halpern, Douglas Wholey

This paper assesses variation in the content of Medicare's local medical review policies.

Structure of Hospital Networks in California Affects Pricing
LeAnne DeFrancesco

The research team, led by Gary Young, Ph.D., and James F. Burgess, Jr., Ph.D., of the Boston University School of Public Health and the U.S. Department of Veterans Affairs found that between 1994 and 1998, the percentage of California hospitals participating in local networks increased from approximately 24 percent to 37 percent. This increase likely reflects the use of networks by hospitals to counter growing competitive and reimbursement pressures, since local hospital networks allow member hospitals to work together in ways that potentially are anticompetitive. The results of the study did not point to a network effect on hospital prices generally. However, a significant price effect was observed for hospitals participating networks that are also embedded in systems.

Managed Care Mandates Fall Short of Curbing California Medicaid Costs
Bonnie Austin

To shed light on the effects of transitioning beneficiaries from FFS Medicaid to Medicaid managed care, Mark Duggan, Ph.D., and colleagues from the University of Maryland and the National Bureau of Economic Research examined how mandatory enrollment in managed care has affected both spending and health outcomes for California Medicaid recipients. They found that despite a dramatic increase in Medicaid managed care enrollment-from less than 12 percent in 1993 to 51 percent in 1999-there was neither a significant reduction in spending nor improved health outcomes.

Exporting the Buyers Health Care Action Group Purchasing Model: Lessons from Other Communities

Jon Christianson and Roger Feldman

This paper examines and analyzes the implementation of the Buyers Health Care Action Group's (BHCAG) purchasing approach in Minneapolis and St. Paul, Minnesota.

The Balanced Budget Act of 1997 and U.S. Hospital Operations

Gloria J. Bazzoli, Richard C. Lindrooth, Romana Hasnain-Wynia, and Jack Needleman

This paper examines the short-term effects of the BBA on the operations of nonprofit hospitals in the United States. It then compares these effects to those observed in the early 1980s during implementation of the Medicare prospective payment system (PPS).

Does Open Enrollment Control Premiums? A Case Study from the “Medigap” Market
Thomas Rice, Katherine A. Desmond, and Peter D. Fox
This article analyzes a change in “Medigap” regulations that occurred in Missouri in 1999, comparing various outcomes in Missouri and those in two comparison states, Kansas and Florida.

Medicare’s National Coverage Decisions, 1999-2003: Quality Of Evidence And Review Times

Peter J. Neumann, Nomita Divi, Molly T. Beinfeld, Bat-Sheva Levine, Patricia Seliger Keenan, Elkan F. Halpern, and G. Scott Gazelle
This article examines examined the quality of evidence for sixty-nine technologies reviewed by Medicare since 1999.

Evaluating Promising New Treatments for Life-Threatening Disease: Implications of the HDC/ABMT Experience for Treating Breast Cancer
Susan Edwards

Four researchers-Richard Rettig, Ph.D. (RAND); Peter D. Jacobson, J.D., M.P.H. (University of Michigan); Cynthia M. Farquhar, M.D. (University of Auckland, New Zealand); and Wade M. Aubry, M.D. (University of California San Francisco and the Health Technology Center)-combined resources to examine how and why
HDC/ABMT for treating breast cancer diffused widely before its effectiveness was established, how and why technology assessments failed to slow diffusion, and how and why RCTs were finally completed and decisively stopped diffusion. They then drew policy lessons for the evaluation of future similar technologies. In the process, they considered the legal, economic, and political factors that influenced these events.

Managed Care Does Not Appear to Have a Spillover Effect on the Quality of Diabetes Care for Medicare Patients
Susan Edwards

Research and policy experts often assume that growth in the market penetration of managed care organizations (MCOs) and the incentives they use to control costs have changed health care market behavior across the board. However, according to new research by Paul L. Hebert, Ph.D., and his colleagues at the Mount Sinai School of Medicine, there is little evidence to suggest a spillover effect of managed care market penetration on individuals with diabetes in the non-managed care sector, specifically Medicare beneficiaries with diabetes enrolled in fee-for-service (FFS) plans.

Marketwatch: Doughnut-Hole Economics
Meredith B. Rosenthal
This article examines the recently enacted Medicare prescription drug benefit and the cohort of consumer-directed health benefit models that offer doughnut-shaped insurance coverage.

Comparing Accuracy of Risk-Adjustment Methodologies Used in Economic Profiling of Physicians

J. William Thomas, Kyle L. Grazier, and Kathleen Ward
This article assesses the relative accuracy of risk-adjustment methodologies used to profile primary care physician practice efficiency.

Mental Health Care Disparities Among Youths Vary by State Mental Health Care Disparities Among Youths Vary by State
Laura McDaniel and Susan Edwards
Only a minority of U.S. children and adolescents who need mental health care are receiving mental health services. Such discrepancies in care appear to vary significantly on a state-by-state basis, according to new HCFO-sponsored research, and the differences
across states are not explained by sociodemographic characteristics such as race and income. Roland Sturm, Ph.D., and Jeanne Ringel, Ph.D., both at RAND, recently completed a study examining differences in mental health need and services use among children and adolescents across 13 states.

The Effects of State Mental Health Parity Legislation on Perceived Quality of Insurance Coverage, Perceived Access to Care, and Use of Mental Health Specialty Care
Yuhua Bao and Roland Sturm

This article assesses the impacts of recent state mental health parity legislation on perceived quality of health insurance coverage, perceived access to needed health care, and use of mental health specialty services by individuals with likely need for mental health care.

Consumer-Driven Health Plans: Early Results from a National Study
Roger Feldman, Ph.D., Stephen Parente, Ph.D., and Jon Christianson, Ph.D.
Roger Feldman and colleagues Stephen Parente and Jon Christianson, from the Carlson School of Management, have published the early results from their national study of consumer-driven health plans (CDHPs). In a set of three papers in Health Services Research, the University of Minnesota researchers provided valuable, unbiased information to the policy and research community about the potential for CDHPs to take hold.

For-Profit Non-Conversion And Regulatory Firestorm At CareFirst BlueCross BlueShield
James C. Robinson
This article examines the attempted non-profit to for-profit conversion of Carefirst BlueCross BlueShield, and the market and regulatory battle that ensued because of this attempted conversion.

Community Rating And Sustainable Individual Health Insurance Markets In New Jersey
Alan C. Monheit, Joel C. Cantor, Margaret Koller and Kimberley S. Fox
This article examines the New Jersey Individual Health Coverage Program (IHCP), which was implemented in 1993. The researchers found the stability of the IHCP to be fragile in light of improving opportunities for job-related health insurance. The researchers also found that IHCP is retaining high-risk enrollees.

Why don't Americans use cost-effective analysis?

Peter J. Neumann, Sc.D.
This paper examines the resistance to cost-effectiveness analysis in the United States and explores ways in which to advance the field.

The Check Is in the Mail: Determinants of Claims Payable Timing among Health Maintenance Organizations

Robert Connor, Douglas R. Wholey, Roger Feldman, and William Riley
This paper used financial data from health maintenance organizations (HMOs) in the United States from the period 1985 to 2001 to examine the determinants of claims payable-the dollar amount of services rendered to enrollees but for which the HMO has not yet paid providers, such as physicians and hospitals. The results show that HMOs manage claims payable with a multi-period perspective designed to evoke favorable responses and to avoid unfavorable ones from external parties, and to maintain flexibility for unexpected conditions.

Private Health Purchasing Practices In The Public Sector: A Comparison Of State Employers And The Fortune 500

James Maxwell, Peter Temin, and Tanaz Petigara
In a recent survey of senior benefit managers, the researchers examine the extent to which states have followed the private-sector approach to purchasing health care. They found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs.

Impact of Managed Care on the Treatment, Costs, and Outcomes of Fee-for-Service Medicare Patients with Acute Myocardial Infarction

M. Kate Bundorf, Kevin A. Schulman, Judith A. Stafford, Darrell Gaskin, James G. Jollis, and Jose J. Escarce
The level of managed care activity in the health care market affects the process of care for Medicare fee-for-service AMI patients. Spillovers from managed care activity to patients with other types of insurance are more likely when managed care organizations have greater market power.

From Managed Care To Consumer Health Insurance: The Fall And Rise Of Aetna

James C. Robinson
This paper documents Aetna's fall as the nation's largest managed care plan and its subsequent reemergence as a smaller but more profitable multiproduct insurer. The paper emphasizes the transformation in corporate goals, product design, organizational structure, information technology, product mix, premiums, cash flow, net income, and share prices. Disciplined underwriting and pricing have restored the firm to profitability and set the foundation for new growth. The implications for the health care system as a whole are less unambiguously positive.

The Effect of HMO Competition on
Gatekeeping, Usual Source of Care, and
Evaluations of Physician Thoroughness
Andrew R. Sommers, MS, MA;
Douglas R. Wholey, PhD

For HMO enrollees, the overall effect of HMO competition is to increase evaluations of physician thoroughness. For those not in HMOs, although there are HMO competition spillover effects, they are offsetting, resulting in no overall effect of HMO competition on evaluations of physician thoroughness.

Some Patients Stop Taking Necessary Medications As Tiered Formularies Shift Costs from Insurers to Employees
Harvard Medical School Press Release
December 3, 2003

Large increases in co-payments in tiered prescription drug plans increase the likelihood that patients will choose not to pay them and to stop taking prescribed drugs, including needed medications for chronic illnesses such as heart disease and acid reflux, according to a study in the New England Journal of Medicine sponsored by the HCFO program, the National Institute of Mental Health, and the Agency for Healthcare Research and Quality.

Findings Brief: Subgroups of Working Uninsured Require Different Enrollment Strategies
AcademyHealth, Vol. 6, Issue 6, December 2003

Today, more than 41 million Americans are uninsured. Perhaps the most perplexing aspect of this problem is that many of the uninsured are employed. New research findings sponsored by the HCFO program show that many specific factors affect the offer or take-up of employer-sponsored insurance, and policies to reduce the number of working uninsured might be more successful if targeted at specific subgroups of workers and employers. Vulnerable subpopulations include: adults without dependent children, Hispanic and non-citizen employees, workers in large firms, and low-income workers. Contrary to widespread belief, many employees are not uninsured due to "low demand" characteristics.

"Health Plan Good 'Catch' for Fishing Industry"
AcademyHealth, Vol. 6, Issue 5, October 2003

The already large numbers of Americans without
health insurance continue to grow as more and more employers respond to high health care costs and a weak economy by cutting back on the coverage they offer their employees. Reformers have focused efforts to reduce their numbers on working people since most of the uninsured are employed. One demonstration program recently targeted people in the fishing industry, who tend to be expensive to insure,
in part because health plan administrators and carriers assume that fishing is a risky line of work that will likely lead to the high
use of health care services. New research at Boston University, however, finds that individuals enrolled in the Fishing Partnership Health Plan (FPHP) were not more likely to use health care services, or incur greater costs, than people with similar insurance who did not fish for a living.