The effect of HIFA waiver expansions on uninsurance rates in adult populations.
OBJECTIVE
To evaluate the effect of the Health Insurance Flexibility and Accountability (HIFA) demonstrations on the rate of uninsured. The policy purpose of the HIFA demonstrations is to encourage "new comprehensive state approaches" that will increase the number of insured. HIFA interventions include changes in benefit packages, eligibility rules for public programs, and state subsidization of private health insurance premiums. Some states emphasized private insurance (premium assistance), whereas others placed greater emphasis on expanded eligibility for public insurance.


METHODS
Data were drawn from the Current Population Survey from 2000 to 2007. The target populations for the HIFA waiver demonstrations consisted of individuals who were eligible for the HIFA waiver demonstrations in demonstration states.


METHODS
The estimation approach was a probit model using a difference-in-differences approach.


RESULTS
In states that fully implemented their HIFA waiver, HIFA increased the rate of insurance coverage by 6.4 percentage points on average in the targeted adult population, suggesting that approximately 118,848 adults gained health insurance due to HIFA. Total HIFA adult enrollment in the six states studied was 280,739. The effect size varied by state, with Maine having the largest effect and Illinois the smallest. The results were robust to different specifications of the control group.


CONCLUSIONS
Our findings suggest that public insurance initiatives that provide states with flexibility regarding eligibility and plan design are a viable policy approach to reducing uninsurance rates.
Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado, 13001 E 17th Place, MS B119, Aurora, CO 80045, USA. adam.atherly@ucdenver.edu
Adam
A
Atherly
Bryan E
BE
Dowd
Robert F
RF
Coulam
Gery
G
Guy
D000328:Adult; D016022:Case-Control Studies; D004608:Eligibility Determination; D005260:Female; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D017059:Models, Econometric; D015999:Multivariate Analysis; D013221:State Health Plans / Q000706:statistics & numerical data*; D014481:United States