title: Sliding-scale premium health insurance programs: four states' experiences.
abstract: As publicly funded health insurance shifts more toward coverage of working families of low and moderate incomes, there has been growing interest in beneficiary cost sharing, in the form of sliding-scale premiums. In the 1990s, Hawaii, Minnesota, Tennessee, and Washington initiated expansion programs that used sliding-scale premiums for working-class families. The experience in these states indicates that it is feasible to require cost sharing of premiums, but there are a number of design and operational complexities. A preliminary analysis indicates that, as expected, higher out-of-pocket premium shares were associated with lower participation rates.
authors.affiliation: Urban Institute, Washington DC 20037, USA.
authors.forename: L
authors.initials: L
authors.lastname: Ku
authors.forename: T A
authors.initials: TA
authors.lastname: Coughlin
mesh_terms: D017047:Cost Sharing / Q000379:methods*; D005240:Feasibility Studies; D005380:Financing, Government / Q000191:economics*; D005382:Financing, Personal / Q000191:economics; D006254:Hawaii; D006302:Health Services Research; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008910:Minnesota; D011203:Poverty / Q000191:economics*; D016730:Program Development; D015397:Program Evaluation; D013714:Tennessee; D014481:United States; D014861:Washington