Management Analysis of Approaches for Expanding Access to Health

Health insurance is the primary way of obtaining access to health care in the U.S. today, but 46 million Americans are uninsured. The provision of health insurance involves extensive interactions between individuals, health insurers, and health care providers, between the public and private sectors, and across levels of government. Expanding health coverage without unduly adding to this complexity represents a major challenge to public administration. Yet is a challenge that can and should be met.

Analyses of proposals to expand health coverage generally focus on their programmatic or policy impact. This emphasis is understandable, since many proposals provide only sketchy information about management, and administrative costs represent only a small portion of the total costs of a proposal. Nonetheless, failure to address matters of implementation can result in policies or programs that cost too much or fail to achieve their goals.

This project examined the management and administrative issues that are likely to arise as part of efforts to expand health coverage. It is the product of a study panel convened jointly by the National Academy of Public Administration (NAPA) and the National Academy of Social Insurance (NASI). To download the study panel's final report, click here.

As part of its work, the study panel also published ten working papers:

• Paying a Fair Share for Health Coverage and Care by Jill Bernstein (consultant)
• Administering Health Insurance Mandates by C. Eugene Steuerle (Urban Institute) and Paul N. Van de Water (NASI)
• Restructuring Health Insurance Markets by Elliot K. Wicks (Health Management Associates)
• Simplifying Administration of Health Insurance by Mark Merlis (consultant)
• The Regulation of Private Health Insurance by Timothy Stoltzfus Jost (Washington and Lee Law School)
• Cost Containment and Coverage Expansion by Mark Merlis (consultant)
• Designing a Mixed Public and Private System for the Health Insurance Market by Bryan Dowd (University of Minnesota)
• Re-figuring Federalism: Nation and State in Health Reform's Next Round by Lawrence D. Brown (Columbia University)
• Designing Administrative Organizations for Health Reform by Paul N. Van de Water (NASI)
• Recent Changes in Dutch Health Insurance by Kieke Okma (New York University)

Study Panel Appointees

The academies appointed the following individuals to oversee and direct the study.

• Robert A. Berenson,+ Co-chair, Senior Fellow, Urban Institute
• William A. Morrill,* Co-chair, Senior Fellow, ICF Consulting
• Kenneth S. Apfel,*+ Professor, School of Public Policy, University of Maryland
• Beth C. Fuchs,+ Principal, Health Policy Alternatives, Inc.
• Thomas R. Hefty, President, Kern Family Foundation
• Feather O. Houstoun,* President, William Penn Foundation
• Robert E. Hurley, Associate Professor, Department of Health Administration, Medical College of Virginia
• Jack Lewin, M.D., Chief Executive Officer, American College of Cardiology
• Catherine G. McLaughlin,+ Professor of Health Management and Policy, School of Public Health, University of Michigan
• Sallyanne Payton,* William W. Cook Professor of Law, Law School, University of Michigan
• Michael C. Rogers,* Executive Vice President–Corporate Services, MedStar Health
• Raymond Scheppach,* Executive Director, National Governors Association
• Mark D. Smith, M.D.,+ President and CEO, California HealthCare Foundation

For more information, contact Paul N. Van de Water,+ Project Director at NASI (vandewater[at]cbpp.org), or Terry F. Buss, Project Area Director at NAPA (tbuss@napawash.org).

This project is funded by a grant from the Robert Wood Johnson Foundation.

*NAPA Fellow
+NASI Member