Increments toward what?

Incremental proposals to expand health insurance coverage, such as expansio ns of the State Children's Health Insurance Program (SCHIP) or creation of new tax credits, should be examined for the values that underlie them and f or how they structure future options for additional incremental coverage ex pansions. This paper examines five design issues in incremental reform: who determines coverage options for the newly insured; what risk pool do they enter; what is the government's contribution toward their coverage; what ba rriers are created by efforts to encourage efficiency; and how are issues o f federalism handled? Tax credits are a departure from past approaches, whi le an SCHIP expansion is a continuation of current policy directions.