States have tried a number of strategies to reduce the growing number
of uninsured people. These include Medicaid expansions and various ins
urance reforms, such as low-cost plans, subsidized insurance products,
risk pooling, open enrollment and continuity of coverage requirements
, and community rating Using data from 1989 to 1994, we examine the im
pact of such policies on health insurance coverage for adults. We find
that few state policies have succeeded in increasing health insurance
coverage. For those that work, impacts are very modest or are accompa
nied by adverse effects such as crowdout. Implementing effective state
policies to reduce the number of uninsured remains a great challenge.