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.
Health Serv Res. 2012 Jun;47(3 Pt 1):939-62. doi: 10.1111/j.1475-6773.2011.01376.x. Epub 2012 Feb 2.
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.
DATA SOURCES/STUDY SETTING: 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.
The estimation approach was a probit model using a difference-in-differences approach.
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.
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.
评估健康保险弹性和责任法案（HIFA）示范对未参保率的影响。HIFA 示范的政策目的是鼓励“新的全面国家方法”，以增加参保人数。HIFA 干预措施包括改变福利包、公共计划的资格规则以及对私人健康保险保费的国家补贴。一些州强调私人保险（保费援助），而另一些州则更强调扩大公共保险的资格。
数据来源/研究设置：数据来自 2000 年至 2007 年的当前人口调查。HIFA 豁免示范的目标人群包括有资格参加示范州 HIFA 豁免的个人。
估计方法是使用双重差分法的概率模型。
在全面实施 HIFA 豁免的州，HIFA 平均使目标成年人群的保险覆盖率提高了 6.4 个百分点，这表明大约有 118848 名成年人因 HIFA 获得了健康保险。在研究的六个州中，HIFA 成年总参保人数为 280739 人。效果大小因州而异，缅因州的效果最大，伊利诺伊州的效果最小。结果在不同的对照组规格下都是稳健的。
我们的研究结果表明，为各州提供资格和计划设计灵活性的公共保险计划是降低未参保率的可行政策方法。
