Sliding Scale Premium Health Insurance Programs

Leighton Ku, Teresa A. Coughlin

As publicly funded health insurance programs shift more toward coverage of working families in low and moderate incomes, there has been a growing interest in beneficiary cost sharing in the form of sliding-scale premiums. In this study we examined four publicly-sponsored health insurance programs aimed at working-class families--Hawaii’s QUEST, Minnesota’s MNCare, Tennessee’s TennCare, and Washington’s BHP. The experience in these states indicates that it is feasible to require cost sharing of premiums, but there are a number of design and operational complexities. A preliminary analysis indicates that higher out-of-pocket premium shares were associated with lower participation rates.(Inquiry Winter 1999/2000; 36(4):471-480).

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