Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

8
Health Policy Goals and Firm Performance: A Transaction Cost Analysis of the Arizona Medicaid Experiment

Carol K. Jacobson


INTRODUCTION

Access to health insurance and medical care services is restricted for the estimated 33 million Americans who do not have health insurance. As a partial solution to the problem of the uninsured, some proposals recommend expanding public Medicaid programs to the private sector. 1 Arizona is one state that has recently expanded its innovative Medicaid program and allowed plans delivering indigent medical care to offer coverage to small employers in the private sector. This chapter discusses the implications of Arizona's unique program for improving access to affordable health insurance.

Within the group of 33 million uninsured, only 15 percent are hard-core unemployed. The remainder are sometimes employed (27 percent), steady part-time workers (8 percent), or employed in full-time jobs (50 percent). 2 Many of the employed but uninsured have jobs in the secondary labor market, characterized by low wages, poor working conditions, and limited job security ( Doeringer and Piore, 1971; Levitan et al., 1981). Such jobs do not offer health insurance or other fringe benefits.

Employer efforts to contain the costs of health care benefits are creating tense employer-employee relations ( Luthans and Davis, 1990). The problems of small firms wanting to offer health benefits are particularly acute. Insurance companies either charge individuals and small groups a higher premium than they charge large groups or refuse to extend coverage to them. In addition, a small group may risk cancellation of coverage if only one employee incurs a large medical claim as a result of an illness such as

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