Health Insurance for Children: Declines in Employment-Based Coverage
Leave Millions Uninsured; State and Private Programs Offer New Approaches
(Testimony, 04/08/97, GAO/T-HEHS-97-105).

GAO discussed recent changes in health insurance coverage and the effect
of these changes on children, focusing on: (1) recent trends in
children's health insurance coverage, particularly in employment-based
coverage; (2) the increasing role of Medicaid in insuring children and
possible interactions with private insurance; and (3) some small-scale
but innovative state and private efforts to provide coverage for
uninsured children.

GAO noted that: (1) while most children have health insurance, almost 10
million children lack insurance; (2) between 1989 and 1995, the
percentage of children with private coverage declined significantly,
part of an overall decline in coverage of dependents through family
health insurance policies; (3) increases in the cost of providing health
insurance have prompted many employers to take steps that discourage or
limit dependent coverage, such as raising premiums or providing
incentive payments to employees who refuse family coverage; (4) this
erosion in employer support for health insurance has contributed to the
increasing number of children in working families without private health
insurance; (5) as these reductions in private coverage were occurring,
Medicaid eligibility for children expanded; (6) these expansions helped
to cushion the effect of the loss of private coverage, but they also may
have contributed to some further reductions in private coverage; (7)
families respond to the availability of public coverage differently; (8)
while some families may have been induced to drop private coverage to
gain Medicaid for the children, others may not have taken advantage of
the program; (9) indeed, almost 3 million Medicaid-eligible children
remain uninsured; (10) a number of states, in conjunction with local
governments, and private entities have developed children's insurance
programs that differ significantly from Medicaid; (11) some of these
public/private efforts may prove instructive in developing future
strategies for insuring children; (12) for example, by targeting their
outreach efforts, the programs have been able to identify uninsured
children, some of whom are eligible for Medicaid; (13) in addition, the
programs have developed service packages based on preventive care and
required parents to assume some of the insurance cost through premium
contributions and copayments for specific services; and (14) such
strategies have helped to stretch program dollars and provide needed
health care to more children.

--------------------------- Indexing Terms -----------------------------

 REPORTNUM:  T-HEHS-97-105
     TITLE:  Health Insurance for Children: Declines in Employment-Based 
             Coverage Leave Millions Uninsured; State and
             Private Programs Offer New Approaches
      DATE:  04/08/97
   SUBJECT:  Children
             Health insurance
             Health care programs
             Employee medical benefits
             State programs
             Insurance premiums
             Non-government enterprises
             Employee benefit plans
IDENTIFIER:  Medicaid Program
             Alabama Caring Program for Children
             Western Pennsylvania Caring Program for Children
             Pennsylvania Children's Health Insurance Program
             New York Child Health Plus Program
             Florida Healthy Kids Program
             MinnesotaCare Program
             
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Cover
================================================================ COVER


Before the Subcommittee on Health, Committee on Ways and Means, House
of Representatives

For Release on Delivery
Expected at 10:00 a.m.
Tuesday, April 8, 1997

HEALTH INSURANCE FOR CHILDREN -
DECLINES IN EMPLOYMENT-
BASED COVERAGE LEAVE MILLIONS
UNINSURED; STATE AND PRIVATE
PROGRAMS OFFER NEW APPROACHES

Statement of William J.  Scanlon, Director
Health Financing and Systems Issues
Health, Education, and Human Services Division

GAO/T-HEHS-97-105

GAO/HEHS-97-105T


(101556)


Abbreviations
=============================================================== ABBREV


HEALTH INSURANCE FOR CHILDREN: 
DECLINES IN EMPLOYMENT-BASED
COVERAGE LEAVE MILLIONS UNINSURED;
STATE AND PRIVATE PROGRAMS OFFER
NEW APPROACHES
============================================================ Chapter 0

Mr.  Chairman and Members of the Subcommittee: 

I am pleased to be here today to discuss recent changes in health
insurance coverage and the effect of these changes on children. 
Without health insurance, many families face difficulties getting
preventive and basic health care for their children.  Children
without health insurance are less likely to have routine medical and
dental care, establish a relationship with a primary care physician,
and receive immunizations or treatment for injuries and chronic
illnesses.  Recognizing the importance of health insurance for
children, Members of the House and Senate and the administration have
proposed expanding children's health insurance coverage--either
through grants to the states, refundable tax credits, vouchers, or
other means. 

My remarks today will focus on three points:  (1) recent trends in
children's health insurance coverage, particularly in
employment-based coverage; (2) the increasing role of Medicaid in
insuring children and possible interactions with private insurance;
and (3) some small-scale but innovative state and private efforts to
provide coverage for uninsured children.  These remarks summarize
findings from previous GAO work, based on our analysis of the Bureau
of the Census March Current Population Surveys for health insurance
coverage in 1989 and 1995 and information from the Census on trends
in coverage from 1987 through 1995; other public and private surveys,
such as a survey conducted by KPMG Peat Marwick on employer health
insurance; interviews with experts, insurance company executives, and
benefits consultants; current research on health insurance issues;
and case studies of state and private programs that insure children. 
(A list of GAO products related to this issue appears at the end of
this statement.)

In summary, we found that while most children have health insurance,
almost 10 million children lack insurance.  Between 1989 and 1995,
the percentage of children with private coverage declined
significantly--part of an overall decline in coverage of dependents
through family health insurance policies.  Increases in the cost of
providing health insurance have prompted many employers to take steps
that discourage or limit dependent coverage, such as raising premiums
or providing incentive payments to employees who refuse family
coverage.  This erosion in employer support for health insurance has
contributed to the increasing number of children in working families
without private health insurance. 

As these reductions in private coverage were occurring, Medicaid
eligibility for children expanded.  These expansions helped to
cushion the effect of the loss of private coverage, but they also may
have contributed to some further reductions in private coverage. 
Families respond to the availability of public coverage differently. 
While some families may have been induced to drop private coverage to
gain Medicaid for their children, others may not have taken advantage
of the program.  Indeed, almost 3 million Medicaid-eligible children
remain uninsured. 

A number of states, in conjunction with local governments, and
private entities have developed children's insurance programs that
differ significantly from Medicaid.  Some of these public/private
efforts may prove instructive in developing future strategies for
insuring children.  For example, by targeting their outreach efforts,
the programs have been able to identify uninsured children--some of
whom are eligible for Medicaid.  In addition, the programs have
developed service packages based on preventive care and required
parents to assume some of the insurance cost through premium
contributions and copayments for specific services.  Such strategies
have helped to stretch program dollars and provide needed health care
to more children. 


   THE DECLINE IN PRIVATE HEALTH
   INSURANCE COVERAGE HIT CHILDREN
   HARDER AS EMPLOYER FINANCIAL
   SUPPORT DECREASED
---------------------------------------------------------- Chapter 0:1

Between 1989 and 1995, private family insurance coverage declined for
both children and working-age adults.  Most of the decline was for
the dependents of workers--most dramatically for children.  During
this period, the percentage of children with private health insurance
dropped from 74 percent to 66 percent.  Had this decrease not
occurred, nearly 5 million more children would have had private
health insurance. 

Eroding employer financial support for providing health insurance to
employees' families has contributed to the overall decline in private
insurance coverage.  The vast majority of privately insured children
are covered under their parents' employment-based health care
plans.\1 But as health insurance premiums reached 10 percent of
employers' payroll costs, many employers began to reconsider the
amount of employee insurance--particularly family coverage--that they
would support.  The health insurance cost to employers for a worker
who does not elect family coverage is less than half the cost of
family coverage.  As a result, firms are considering a variety of
ways to control the cost of coverage--particularly family coverage. 

There was a slight decrease in the proportion of workers whose
employers sponsored health insurance between 1988 and 1993.  The
decrease was more pronounced among those working in small firms--13
percent fewer people working for firms with fewer than 10 employees
had employers who sponsored coverage.  Even if an employer sponsors a
plan, it may not cover family members.  In 1993, almost one-quarter
of the workforce could not get family coverage at work.  Over 18
million workers were employed by firms that did not sponsor coverage
at all, and more than 5 million workers worked for firms that
sponsored coverage for workers, but not family members. 

Most employers that offered coverage raised employee premium
contributions significantly--especially for family coverage.  In
large firms with 100 or more employees, average monthly premium
contributions increased 79 percent for family coverage compared with
64 percent for single coverage between 1988 and 1993.  A Hewitt
Associates analysis of benefits offered by a group of major firms
with 1,000 or more employees showed that median monthly premium
contributions for family indemnity coverage increased 64 percent
between 1990 and 1995, whereas median monthly premium contributions
for employee-only indemnity coverage increased 47 percent. 

In addition to increasing premium contributions, employers are
increasingly turning to other options in their benefit design to
limit their costs.  These options may discourage family coverage but
may also result in employers of two-income families sharing in the
cost of coverage and avoiding the cost of duplicate coverage.  These
options include

  -- providing alternative benefits or incentives to workers who
     choose employee-only coverage,

  -- providing financial incentives to employees who obtain family
     coverage through their spouse,

  -- refusing to cover a spouse if the spouse has other health
     insurance,

  -- imposing a surcharge for working spouses covered as dependents,

  -- refusing to provide dependent coverage unless the employee is
     the family's primary wage earner, and

  -- changing premium structures so that larger families pay higher
     premiums. 


--------------------
\1 For information on the structure of the private market for
individual coverage, see Private Health Insurance:  Millions Relying
on the Individual Market Face Cost and Coverage Trade-Offs
(GAO/HEHS-97-8, Nov.  25, 1996). 


   EXPANDED MEDICAID COVERAGE
   OFFSET MUCH OF THE DECLINE IN
   PRIVATE COVERAGE FOR CHILDREN
---------------------------------------------------------- Chapter 0:2

Between 1989 and 1995, the number of children in the United States
increased by almost 7 million, but the number of children with
private health insurance coverage remained virtually unchanged. 
During this same period, Medicaid eligibility for children expanded
so that poor and near-poor children under age 12 became eligible,\2
and enrollment increased by 6 million children.  Despite the growth
in Medicaid, the number of uninsured children grew by more than 1
million--reaching almost 10 million uninsured children by 1995. 

There is considerable debate about the extent to which expanding
Medicaid eligibility contributed to the decline in the percentage of
children who had private coverage.  For example, one study suggests
that as much as one-sixth of the overall decline in the proportion of
people with private coverage may have occurred because families
dropped their insurance to enroll children and pregnant women in
Medicaid.\3 However, other studies found a lesser effect or no effect
at all.\4

Regardless, the studies indicate that, at most, one-sixth of the loss
in private coverage stems from families' choosing to substitute
Medicaid for private coverage.  Consequently, had Medicaid
eligibility not been expanded, the number of uninsured children would
probably have been even greater. 

Moreover, Medicaid expansions could have reduced the number of
uninsured children even more, but many uninsured children who are
eligible for Medicaid do not enroll.  In 1994, almost 3 million
Medicaid-eligible children lacked health insurance.  Our previous
work and that of other researchers points out several reasons
families do not enroll their eligible children in the Medicaid
program.  Some low-income families are unaware that their children
may be eligible for Medicaid, and some are stymied by the complexity
of the enrollment process.  Moreover, some families may not consider
health coverage necessary until a child experiences a medical crisis. 
The stigma associated with participation in a publicly funded health
insurance program can also deter some families. 

While states have developed Medicaid outreach programs, their past
outreach efforts focused more on encouraging use of preventive care
by current participants than on encouraging new enrollment.  The
Health Care Financing Administration and the Health Resources and
Services Administration are in the preliminary stages of developing a
more aggressive outreach program for potential Medicaid
beneficiaries. 


--------------------
\2 Beginning in 1986, the Congress passed a series of laws that
expanded Medicaid eligibility for pregnant women on the basis of
family income and eligibility for children on the basis of family
income and age.  Before these eligibility expansions, most children
received Medicaid because they were enrolled in Aid to Families With
Dependent Children.  Starting in July 1989, states were required to
expand coverage for pregnant women and infants with family incomes at
or below 75 percent of the federal poverty level.  Two subsequent
federal laws further expanded mandated eligibility for pregnant women
and children.  By July 1991, states were required to cover (1)
pregnant women, infants, and children up to age 6 with family income
at or below 133 percent of the federal poverty level and (2) children
6 years old and older born after September 30, 1983, with family
income at or below 100 percent of the federal poverty level. 

\3 See David M.  Cutler and Jonathan Gruber, Does Public Insurance
Crowd Out Private Insurance?  Working Paper No.  5082 (Cambridge,
Mass.:  National Bureau of Economic Research, Apr.  1995). 

\4 See Lisa Dubay and Genevieve Kenney, Revisiting the Issues:  The
Effects of Medicaid Expansions on Insurance Coverage of Children
(Washington, D.C.:  The Urban Institute, Oct.  1995); Lara D. 
Shore-Sheppard, "Stemming the Tide?  The Effect of Expanding Medicaid
Eligibility on Health Insurance Coverage," unpublished draft, Nov. 
1995; Lara D.  Shore-Sheppard, "The Effect of Expanding Medicaid
Eligibility on the Distribution of Children's Health Insurance
Coverage," paper presented at the Cornell/Princeton Conference on
Reforming Social Insurance Programs, May 1996; and Esel Y.  Yazici,
"Medicaid Expansions and the Crowding Out of Private Health
Insurance," paper presented at the 18th Annual Research Conference of
the Association for Public Policy Analysis and Management,
Pittsburgh, Pa., Nov.  2, 1996. 


   STATES, LOCALITIES, AND PRIVATE
   ORGANIZATIONS HAVE CREATED NEW
   STRATEGIES TO INSURE CHILDREN
---------------------------------------------------------- Chapter 0:3

While many states expanded Medicaid beyond federal requirements to
cover more uninsured children, a few developed innovative programs to
offer subsidized coverage apart from Medicaid.  By 1996, 9 states had
state- and locally funded programs, and 24 states had privately
funded programs.  While most of these programs are small in scale,
they do provide important lessons regarding program design
characteristics. 

In earlier work that we conducted on six of these state-funded or
privately funded programs in five states,\5 we found that while the
programs' approaches varied significantly, they shared some common
characteristics.  In some ways, they differed strikingly from
Medicaid. 

  -- Unlike state Medicaid programs, which operate as open-ended
     entitlements, all the programs capped enrollment to stay within
     their fixed budgets.  The state programs' funding came from
     state general revenues; dedicated shares of specialized taxes,
     such as tobacco taxes or health care provider taxes; local tax
     revenue; and grants and donations from foundations and other
     private-sector entities.  The private programs raised money
     through private donations, many with considerable support from
     Blue Cross/Blue Shield organizations. 

  -- All of the programs we visited were designed to augment the
     existing range of coverage options by covering uninsured
     children not eligible for Medicaid.  Two of the programs allowed
     children of any income to join, but families with higher incomes
     were responsible for paying full premium costs. 

  -- All six programs required at least some of the families to share
     in the costs of coverage through premiums and copayments--with
     the families' share increasing as income increased.  For
     example, Pennsylvania's Children's Health Insurance Program
     charged nothing for children in families with income below 185
     percent of the federal poverty level and charged $29 to $34 per
     month per child for children in families with income between 185
     and 235 percent of the federal poverty level.  All programs
     heavily subsidized premiums for the lowest-income
     children--ranging from charging families nothing to charging $10
     per child per month for children with family income at or below
     130 percent of the federal poverty level.  In every program,
     most children received the maximum subsidy.  (See app.  I.)

  -- While all six programs covered basic preventive and outpatient
     services, some limited other services, such as vision, hearing,
     dental, and mental health care.  Some also limited inpatient
     care, particularly the privately funded programs.  The programs
     that limited inpatient services sometimes did so anticipating
     that the children would qualify for Medicaid if they needed more
     extensive care. 

  -- The programs were developed to be easily administered.  Most
     operated, at least partially, through nonprofit or private
     insurers, which enabled the programs to use existing provider
     payment systems and physician networks, guaranteeing patient
     access to providers. 

  -- Each of the six programs worked extensively to reach families of
     uninsured children and to promote their knowledge of the
     program.  One program worked through the schools, which allowed
     it to most easily reach its target group:  school-aged children. 
     Other outreach efforts included dedicated hot lines, television
     and radio ads, bus billboards, posters in local discount stores,
     fast-food restaurant tray liners, and presentations provided at
     churches and other community locations.  To encourage
     enrollment, three programs used sports and television
     personalities as program spokespersons.  These outreach efforts
     served to identify not only children eligible for the six
     programs but also children eligible for Medicaid, who were then
     channeled into that program. 

  -- Each of the six programs developed simplified enrollment
     procedures and took specific steps to avoid the appearance of a
     welfare program. 


--------------------
\5 We visited the Alabama Caring Program for Children, the Western
Pennsylvania Caring Program for Children, Pennsylvania's Children's
Health Insurance Program, New York's Child Health Plus Program, the
Florida Healthy Kids Program, and MinnesotaCare.  MinnesotaCare began
as a state-funded program, but Medicaid began to fund children
participating in the program as of July 1995 through Minnesota's
Medicaid 1115 waiver.  The children's portion of MinnesotaCare is
still distinct from its Medicaid program, however. 


   CONCLUSIONS
---------------------------------------------------------- Chapter 0:4

Although most children are still covered by private employment-based
insurance, recent erosion of private coverage has left many children
without coverage.  The Medicaid expansion has cushioned the effect of
this erosion on children.  However, efforts to expand coverage for
children need to be developed in ways that do not supplant existing
private coverage.  Despite the Medicaid expansion, many uninsured
children who are eligible for Medicaid do not enroll.  Outreach
strategies developed by state and private programs could guide state
efforts to reach uninsured children who are eligible for Medicaid but
not enrolled.  Other innovative state and private strategies, such as
sliding-scale premiums and cost sharing for program enrollees, could
provide a model for enrolling more uninsured children while
controlling costs.  However, adopting other strategies, such as
limiting services like inpatient care on the premise that other
funding may be available, may not provide the range of coverage that
children need. 


-------------------------------------------------------- Chapter 0:4.1

Mr.  Chairman, this concludes my statement.  I would be happy to
answer any questions you or Members of the Subcommittee may have. 


   CONTRIBUTORS
---------------------------------------------------------- Chapter 0:5

For more information on this testimony, please call Michael Gutowski,
Assistant Director, on (202) 512-7128.  Other major contributors
included Sheila K.  Avruch and Karen M.  Sloan. 


COMPARISON OF FAMILY COST-SHARING
PROVISIONS, OCTOBER 1996
=========================================================== Appendix I

                     Income        Family
                range, as a       premium
                 percentage  contribution
                 of federal     per month    Percentage
                    poverty  per child by   enrolled by                Service and amount
Program               level  income range  income range  Copayments    of copayment
-------------  ------------  ------------  ------------  ------------  ------------------
Alabama         $0-12,000\a            $0           100  Yes\b         Outpatient
Caring                                                                 services-$5
Program for
Children

Florida               0-130        5-10\c            68  Yes           Prescription
Healthy Kids        131-185       13-30\c            15                drugs-$3, eyeglass
Program            over 185       45-60\c            17                lenses-$10,
                                                                       refractions-$3,
                                                                       nonauthorized
                                                                       emergency room
                                                                       visits-$25

MinnesotaCare         0-150             4          66\d  No            None for children
                    151-275        4-98\e          34\d                or pregnant women;
                                                                       for other adults,
                                                                       prescription
                                                                       drugs-$3,
                                                                       eyeglasses-$25,
                                                                       inpatient hospital
                                                                       charges-10%

New York's            0-159             0            86  Yes           Prescription
Child Health        160-222          2.08            13                drugs-$1-3,
Plus Program       over 222    35-66.50\c             1                inappropriate
                                                                       emergency room
                                                                       use-$35

Pennsylvania'         0-184             0          95\f  Yes           Prescription
s Children's        185-235        28.74-           5\f                drugs-$5
Health                            34.39\c
Insurance
Program

Western               0-184             0            96  Yes           Prescription
Pennsylvania        185-235      20/up to             4                drugs-$5
Caring                             50 per
Program for                        family
Children
-----------------------------------------------------------------------------------------
Note:  This appendix corresponds with enclosure IV in GAO/HEHS-97-40R
and updates table 2 in GAO/HEHS-96-35. 

\a Alabama uses absolute dollar amounts for income eligibility
determination. 

\b Preferred doctors may require a $5 copayment for some services;
however, most doctors waive the copayment. 

\c Premium contribution varies by locale or insurer. 

\d Estimated by program officials for 1995. 

\e Premium contribution varies by income level within specified range
and family size. 

\f Estimated by program officials for 1996. 


AVERAGE COST PER CHILD PER MONTH
FOR SERVICES COVERED BY PROGRAMS,
OCTOBER 1996
========================================================== Appendix II

                                                                Pennsylvania
                 Alabama                            New York's            's      Western
                  Caring     Florida                     Child    Children's  Pennsylvani
                 Program     Healthy                    Health        Health     a Caring
Costs/               for        Kids  MinnesotaCar        Plus     Insurance  Program for
services        Children     Program             e     Program       Program     Children
------------  ----------  ----------  ------------  ----------  ------------  -----------
=========================================================================================
Average cost      $20.00      $49.00        $60.00    $56.45\b      $52.00\c       $70.62
 per                                                                  $63.00
 child per
 month\a

Services
-----------------------------------------------------------------------------------------
Primary and            ï¿½           ï¿½             ï¿½           ï¿½             ï¿½            ï¿½
 preventive
 care\d
Emergency              ï¿½           ï¿½             ï¿½           ï¿½             ï¿½            ï¿½
 and
 accident
 care
Speech                           ï¿½\e             ï¿½                         ï¿½            ï¿½
 therapy
Physical and                     ï¿½\e             ï¿½           ï¿½             ï¿½            ï¿½
 occupational
 therapy
Prescription                       ï¿½             ï¿½           ï¿½             ï¿½            ï¿½
 drugs
Hospitalizat                       ï¿½             ï¿½          \b           ï¿½\e          ï¿½\e
 ion and
 inpatient
 physician
 services
Mental                           ï¿½\e             ï¿½                       ï¿½\e          ï¿½\e
 health care
Substance                        ï¿½\e             ï¿½         ï¿½\e
 abuse care
Vision care                      ï¿½\e             ï¿½                       ï¿½\e          ï¿½\e
Hearing care                       ï¿½             ï¿½                         ï¿½            ï¿½
Dental care                                      ï¿½                         ï¿½            ï¿½
Home health                        ï¿½             ï¿½                         ï¿½            ï¿½
 care
Ambulance                          ï¿½             ï¿½                                      ï¿½
 services
Durable                            ï¿½             ï¿½                                      ï¿½
 medical
 equipment
 and
 prosthetic
 devices
Podiatry                         ï¿½\e             ï¿½
Chiropractic                     ï¿½\e             ï¿½                                    ï¿½\f
 services
Family                             ï¿½             ï¿½
 planning
Other                  ï¿½         ï¿½\g             ï¿½           ï¿½             ï¿½            ï¿½
 services
-----------------------------------------------------------------------------------------
Note:  This appendix corresponds with enclosure III in HEHS-97-40R
and updates figure 3 in GAO/HEHS-96-35. 

\a Average cost reflects the total premium cost, regardless of the
funding source, but excludes program administrative costs. 

\b New York planned to add inpatient services and reset premiums to
cover these additional services in 1997. 

\c Average cost for fully subsidized children aged 1 through 17 is
$52 per child per month and for partially subsidized children birth
through age 5 is $63 per month. 

\d Primary and preventive care services include well-child visits,
immunizations, diagnostic testing, outpatient physician services, and
outpatient surgery. 

\e These services have specific limitations. 

\f Chiropractic services are covered if ordered by the primary care
physician. 

\g Preventive dental care is offered in some counties. 


RELATED GAO PRODUCTS
=========================================================== Appendix 1

Employment-Based Health Insurance:  Costs Increase and Family
Coverage Decreases (GAO/HEHS-97-35, Feb.  24, 1997). 

Children's Health Insurance Programs, 1996 (GAO/HEHS-97-40R, Dec.  3,
1996). 

Private Health Insurance:  Millions Relying on Individual Market Face
Cost and Coverage Trade-Offs (GAO/HEHS-97-8, Nov.  25, 1996). 

Medicaid and Uninsured Children, 1994 (GAO/HEHS-96-174R, July 9,
1996). 

Health Insurance for Children:  Private Insurance Coverage Continues
to Deteriorate (GAO/HEHS-96-129, June 17, 1996). 

Medicaid:  Spending Pressures Spur States Toward Program
Restructuring (GAO/T-HEHS-96-75, Jan.  18, 1996). 

Health Insurance for Children:  State and Private Programs Create New
Strategies to Insure Children (GAO/HEHS-96-35, Jan.  18, 1996). 

Medicaid and Children's Insurance (GAO/HEHS-96-50R, Oct.  20, 1995). 

Health Insurance for Children:  Many Remain Uninsured Despite
Medicaid Expansion (GAO/HEHS-95-175, July 19, 1995). 

Medicaid:  Spending Pressures Drive States Toward Program Reinvention
(GAO/HEHS-95-122, Apr.  4, 1995). 

Medicaid:  Experience With State Waivers to Promote Cost Control and
Access Care (GAO/HEHS-95-115, Mar.  23, 1995). 

Uninsured and Children on Medicaid (GAO/HEHS-95-83R, Feb.  14, 1995). 

Tax Policy:  Health Insurance Tax Credit Participation Rate Was Low
(GAO/GGD-94-99, May 2, 1994). 

Employer-Based Health Insurance:  High Costs, Wide Variation Threaten
System (GAO/HRD-92-125, Sept.  22, 1992). 

Access to Health Insurance:  State Efforts to Assist Small Businesses
(GAO/HRD-92-90, May 14, 1992). 


*** End of document. ***