Working on the Puzzle : Health Care Coverage for Low-Wage Workers

The article proposes that an "incremental" state-based/public-private approach to expanding access for health care coverage is underway. Two major shifts are encouraging this approach: the movement down of public programs through devolution to the states, and movement out toward increased reliance on private institutions to satisfy public needs. Wisconsin's BadgerCare, a program to cover working low-income families, is used as an example of how the interaction of welfare reform with workplace health coverage gaps created a state impetus towards expanded coverage. That impetus combined with the flexible use SCHIP funding has allowed states to pursue a viable strategy of expanded coverage. The move to public-private coordination has allowed states to develop private-public systems to provide the coverage. These systems employ mechanisms that not only provide coverage but also link across states through intermeshing a knowledge base and actors. The mechanisms include local collaborations, community-based delivery systems, networks, and outcomes processes. The article concludes with a discussion of three challenges to the incremental approach: linking public and private plans, meeting workplace and workforce needs. and integrating the safety net into the mainstream health care financing system