Comment on "Making Work Pay II"

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This paper is a response to New Safety Net Paper 2, "Making Work Pay II: Comprehensive Health Insurance for Low-Income Working Families," by Cynthia D. Perry and Linda J. Blumberg.

The topic could not be more important to upcoming health policy debates. The paper is well-written and argued, and will make important contributions to that debate, and so I wholeheartedly applaud Perry and Blumberg at the outset. My comments are aimed at highlighting what I think are the most important contributions of the paper and at strengthening the core proposal elements against questions and critiques that might be leveled at the authors from less sympathetic readers.
First, the praise.

1. The paper describes the realities of low-income family access to affordable health insurance and health care very well. Even many policy wonks are unaware of what fraction of low-income individuals is ineligible for public insurance and yet lacks access to employer-sponsored insurance, even if individuals could afford the latter. It is helpful and good to emphasize and to spread awareness of these data.
2. The paper’s policy proposal itself is comprehensive and spans mechanisms for expanding coverage, integrating existing programs (e.g., Medicaid/SCHIP) into the new system, and articulating proper roles for individuals, employers, and governments at various levels. It also makes clear the need for systemic cost growth containment over time. The paper thus joins an elite but growing group of proposals that speak of “health reform” as far more than just financing shifts to cover the uninsured, though the best continue to include that bedrock goal.

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The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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