Getting Access to Health Care: Potential Problems if Reform Efforts Succeed

Potential eligibility and enrollment barriers under health reform

This contract, awarded to Sarah Shuptrine and Associates in 1994, was for an ongoing analysis of major health reform proposals, to identify eligibility and enrollment barriers and recommend ways to reduce or avoid barriers.

Three reports were planned. However, the failure of President Clinton's health reform plan compelled a change in the project, and project staff completed only two reports.

Key Findings

  • The first report, Eligibility and Enrollment in National Health Reform: Report #1, was a side-by-side comparison of the Clinton proposal and five other bills in Congress.

  • The second report, Assuring Access to Health Coverage: A Discussion of Eligibility and Enrollment Issue, summarized eligibility and enrollment issues. Recommendations included:

    • Legislative language should make clear that the purpose of the enrollment process is to identify and serve people who are eligible, rather than to disqualify otherwise eligible people on procedural grounds.
    • Outreach programs should be established to assist target populations with enrollment.
    • Applicants should be allowed to declare their income if an employer does not cooperate with verification.
    • Supplemental Security Income recipients should be automatically eligible for Medicaid in all states.