SPG synthesis report - State Coverage Initiatives

� Hawaii’s state-level survey entailed over-sampling less populated counties and
was crucial in producing both county-level estimates and estimates of the state’s
unique ethnic mix. These findings helped inform stakeholders and policy makers.
� Illinois’ state-level survey produced data that focused coverage expansion efforts
on development of an affordable health coverage product for small employers
with 25 or fewer workers who do not currently offer health coverage. Following a
series of statewide meetings, Illinois launched a pilot project in St. Clair County,
one of the most economically disadvantaged areas of the state.
� Armed with state-level survey results that examined smaller geographic areas,
local communities in Massachusetts pinpointed local needs and tailored grant
applications.
� In Minnesota, the state-level survey has allowed the state to add questions on
topics of specific policy-interest from year to year. Examples of topics addressed
by the state-level survey have included dental insurance, supplemental insurance,
and prescription drug coverage.
� Montana used detailed survey data to apply and receive funding for community
health centers.
Several states commented that both the quantitative and qualitative data collection helped
move the policy discussion from anecdotal conversations to substantive discussions of
policy options. States found that quantifying the dimensions of the problem gave policy
makers ownership of the issue. In a 2006-2007 SPG grantee survey conducted by
SHADAC three-fourths (75 percent) of respondents considered the household survey data
“extremely valuable” and no respondents considered it “not at all valuable.” When
presented with a list of topics commonly addressed by the household surveys undertaken
by SPG states, information on the working uninsured, income differences, regional and
local estimates, and age differences topped states’ list of the most important health
insurance coverage issues addressed by household surveys. States said that the most
important issues addressed in their household surveys that related to access include
utilization of health care services, financial and non-financial barriers to care, and
emergency room access. 20
State-specific, and in many cases, county-level and sub-population data highlighted the
saliency of the problem and helped states challenge myths that had previously hindered
productive policy debate. In this sense, the data collection activities were successful in
moving states toward action in considering coverage reforms that would either enhance
current programs to address the uninsured or develop new ones.
Examples where data gathered from state household surveys helped build consensus and
momentum for health coverage strategies include the following. 21
� County-level estimates produced by Hawaii were important in building consensus
among key policy makers, community groups, and other stakeholders.
� Oregon conducted a children’s access survey, which was a critical element in the
eventual development of the state’s Healthy Kids proposal. Policy analysts found
that local data on uninsured children helped involve legislators in developing and
30