OVERVIEW

States can take a number of other actions to improve access for families and small businesses to more affordable options for health care, including:

• Coverage for Young Adults: Requiring insurance companies to allow children to stay on their parent's health insurance well into their 20's can help cover one of the fastest growing segments of the population without health insurance.  Of the 45 million uninsured in the US, 31% are between 19 and 29 years of age.  Eleven states have authorized coverage up to age 25, but New Jersey has extended dependent coverage to age 30.
• Pre-Tax Employee Premium Payments: Requiring employers to set up "section 125 plans," which allow employees to pay their share of employer-based health insurance premiums pre-tax, can help working families better afford private insurance.
• Pooling Public and Private Coverage: In 2008, legislators in Connecticut passed - but the Governor vetoed - an expansive pooling initiative allowing small businesses and municipalities to pool with the 200,000 members of the strong state employee health plan.  Proponents of HB 5536 projected millions of dollars in savings to municipalities.  While over 20 states allow for the pooling of municipal and state employees, Connecticut would have been the first to extend that option to small businesses.
• Standardized Benefit Plans: Requiring insurers in a particular market to include a certain level of benefits in all their insurance options helps ensure people have coverage for the care they need and get value for their insurance premiums. This prevents insurers from selling inadequate insurance and allows consumers to better compare the value of different health plans.  And, as Community Catalyst points out, states can also establish maximum premiums and out-of-pocket costs to protect consumers from medical debt and bankruptcy.
• Merging Insurance Markets: Combining the individual and small group markets can make more affordable options available to small businesses and to individuals, in particular.  Massachusetts has merged these markets and early projections estimate the move will reduce individual insurance premiums by 15% and cause only a slight up-tick in small group premiums.  Community Catalyst found this works best if the two markets have similar consumer protections.

There are worrisome trends in states, as well.  Indiana, in 2007, and Florida, in 2008, both enacted new programs that provide reduced benefit and high deductible plans to low income and uninsured residents.  Such programs do not provide access to affordable and comprehensive coverage, leaving people under-insured and without coverage for the care they need.

Resources:

Commonwealth Fund - Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help, 2008 Update

Families USA and Community Catalyst - A Consumer Guide to State Health Reform: Additional Strategies for Increasing Access to Private Insurance

Connecticut - HB 5536, Connecticut Healthcare Partnership

Georgetown University - State Consumer Guides for Getting and Keeping Health Insurance