There is a real difficulty in building a consensus for a particular approach. An analyst in one state basically told me "We need a break from Medicaid." It is really hard to figure out what vehicle to choose. There is support for a number of different approaches. It is a zero sum game in states. You almost always have to take something away from somebody who has got it in order to get something new, and that is very hard.

Shelly Gehshan

National Conference of State Legislatures, Washington, DC

Public Workshop, June 2, 1997

From the perspective of employers, health care coverage was never considered an entitlement. It was always a way of paying additional compensation, and employers have had to address equity issues between employees. Say you have two employees who are performing the same job and one is single and one has a family. The one with the family would be earning more in compensation because of their family, not because they are taking on any additional responsibilities and functions. With spiraling health care costs, many employers have asked employees to contribute more towards their share of health coverage, especially toward family coverage, to address the equity issue.

Kim Monk

Washington Business Group on Health, Washington, DC

Public Workshop, June 2, 1997

It's very important to worry about safety net providers because they are doing very critical work in our communities. But I would hope that we come to some lessons about the value of insuring individuals and creating financial resources which follow the individual, as opposed to trying to set those resources into the institutions. That, it seems to me, is a policy that has failed.

Kay Johnson

George Washington University, Washington, DC

Public Workshop, June 2, 1997

The committee's goal for this report, therefore, was to draw a general set of conclusions about ways to help improve children's access to care that would apply to a variety of public and private insurance programs. The committee hopes this report will help to improve the evidence base for children's health insurance efforts and for efforts to improve the quality of children's health care. The committee's specific concerns about the need for data to evaluate the SCHIP program and its recommendations for designing a system of accountability for SCHIP are presented separately (IOM, 1998).

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