Covering the Uninsured: How to Administer Expanded Medicaid + Tax Credits

Exploring expanding coverage by integrating state Medicaid programs with federal tax credits

A 2003 article in the journal Health Affairs proposed a combination of liberal and conservative strategies for extending health care coverage to uninsured Americans, combining tax credits with an expansion of public insurance programs. The design of such a program would be extremely complex because of differences between the tax system and the administration of health care programs.

From 2005 to 2007, researchers and consultants at the Health Insurance Reform Project at George Washington University, working with the National Academy of State Health Policy and more than 30 experts, carried out a project to determine the administrative changes that the federal government, state government and employers would have to make if Congress enacted such a health care reform initiative.

Key Results:

  • A February 2007 report, Administering a Medicaid + Tax Credits Initiative, outlined elements of a system to improve and expand health insurance coverage, including:
    • Eligibility based on adjusted gross income for both federal and state assistance.
    • A one-page application for health insurance and tax credits.
    • Administration through the payroll deduction system for workers and their families, who are 80 percent of the uninsured.
    • A competitive insurance market based on the plan that covers federal employees.
    For additional information see Program Results on ID# 052038.