EBRI Issue Brief

States and Their Role in the U.S. Health Care Delivery System

Jan 1, 1991 15  pages


  • Qualifying income limits for Medicaid eligibility in 1989 ranged from 28 percent to 106 percent of the federal poverty level.
  • Of the estimated 1 percent of Americans under age 65 who are uninsurable, approximately 60,000 participate in state risk pools.
  • One study found that if there were no state mandates (including continuation-of-coverage mandates), 16 percent of those small firms not now offering health insurance would begin to do so.
  • Seven states recently passed legislation exempting small employers that do not offer health insurance from state mandates on coverage.
  • It has been estimated that about 50,000 Hawaiians (about 5 percent of the state population) fall through the gap between Medicaid and mandated employer-sponsored health coverage and are left without insurance.
  • Maine recently established a five-year demonstration project, to begin in 1992, in which advisory committees in designated medical specialty areas develop practice parameters. These parameters, or protocols, will be used as evidence in medical liability suits.
  • Several states, including Iowa, Florida, and Pennsylvania, have developed programs that collect and disseminate detailed information about hospital costs. This information allows purchasers to compare hospital costs by diagnosis.
  • The effects of certificate-of-need (CON) laws vary considerably among states: one study found that more stringent CON regulation actually increased hospital costs, while another found that, after controlling for patient and hospital characteristics, states with stringent CON programs had higher mortality rates among Medicare patients than states without such programs.