Goal:

To build knowledge about the availability, as well as costs and quality, of employer-sponsored health insurance in California and to help shape policies to increase the numbers of Californians who have health coverage.

Objectives:

• Develop and disseminate an annual report to inform policymakers.
• Identify and support efforts seeking to expand the number of Californians who have access to health insurance.
• Sponsor an annual conference that brings together policymakers and advocates.

Accomplishments:

• Production of a credible and widely used annual report. Over the last five years, the annual report on health insurance coverage in California has clearly filled a niche for credible health insurance data. The annual report makes available important information about the number of uninsured in California, employer patterns of offering health insurance to their employees, health care industry practices and the availability of health promotion services. It is used by legislators, health policy advocates, legislative staff and other stakeholders because the data is considered credible and reliable. Researchers also responded to hundreds of requests for additional data estimates and policy analyses.
• Establishment of an annual conference. The annual Insure the Uninsured Program conference created a unique place for networking and information sharing. Knowledgeable speakers, facilitators and conference coordinators ensured substantial depth in the panel presentations and small group discussions. This was the only statewide conference that brought together institutional representatives, academicians, health policy advocates and community advocates, and also drew legislative staff and governmental department heads to discuss the issue of the uninsured.

Challenges: 

• Failed partnership. The HIPP program started as a joint partnership between the UC Berkeley School of Public Health as the lead grantee and the UCLA-Center for Health Policy Research as the subcontractor. As the program evolved, issues around production and dissemination of the report ultimately led to termination of the partnership after publication of the fourth annual report in May 2000.
• Achievement of policy goals. A challenge for the Health Insurance Policy Program was to support the development of state policy to increase access to health insurance for employees and their dependents that is not only affordable, but also comprehensive and emphasizes health promotion and disease prevention. To effect this change, the HIPP program took a knowledge-building approach and developed a dissemination strategy to get information into the hands of policymakers. This was a very effective approach but may have been enhanced by a more overt policy advocacy component.

Lessons Learned:

• Communicating comprehensive information about health insurance coverage in California in one annual report was a highly successful strategy for informing the policymaking audience. The Initiative evaluation consistently showed that policymakers, legislative staff and health policy advocates recalled receiving the report and its contents. Though most attention by the media and users focused on the numbers of uninsured, health promotion professionals also utilized the data on insurer practices in the area of health promotion and disease prevention.
• Health promotion and disease prevention information in the annual report was given less attention by policymakers. The Initiative evaluation consistently showed that those who received the report were most interested in the figures on California’s uninsured. Policymakers wanted to know how many people were uninsured, and if possible, how many lived in their jurisdiction. There was less interest in the information about the availability of health promotion and disease prevention services.
• The problem of health insurance is extremely complex and highly politicized. There are many stakeholders and interests involved in addressing the issue of the uninsured. Health philanthropy is a player in the problem-solving process yet is challenged to find strategic ways to be part of the long-term solution. TCWF took an appropriate position by focusing on getting information into the hands of people who are creating solutions.
• Program partnerships require clarity of roles. The lesson to take from the failed partnership in HIPP is that effective partnerships require clarity and agreement about roles and responsibilities. Lack of clarity and agreement about respective roles makes it difficult to work effectively and impedes smooth program implementation.