CHCF and Economic and Social Research Institute Create Framework to Evaluate Coverage Expansion Approaches

Online resources compare alternative models for expanding health coverage in California

California policymakers and the general public can now more easily compare the different approaches to expanding health care coverage for the uninsured thanks to a new online resource developed by the California HealthCare Foundation (CHCF) and the Economic and Social Research Institute (ESRI).

The Coverage Expansion Resource Center (available online through the link below) outlines a framework for assessing and comparing coverage expansion proposals, and uses it to evaluate California’s present health insurance system alongside five alternative models for expanding coverage.

“It is difficult for policymakers and the general public to compare features or assess trade-offs among proposals for expanding health care coverage in California and across the nation,” said Jill M. Yegian, Ph.D., director of CHCF’s Health Insurance Program. “The online tools at the Resource Center provide a simple, consistent approach to assessing proposals, enabling people to make an apples-to-apples comparison.”

The Coverage Expansion Resource Center features a new framework tool for evaluating alternative proposals using four central questions:

  • Coverage: Who is covered and how comprehensive is the plan?
  • Cost and efficiency: How will the proposal affect costs and what approach is taken to manage costs over time and ensure sustainability?
  • Fairness and equity: Who is eligible for government programs and subsidies, and who pays the bill?
  • Choice and autonomy: How much consumer choice does the plan permit? How does the proposal affect provider pricing and clinical autonomy?

“The framework, developed with the guidance of a panel of California and national health experts, will be an invaluable tool for analyzing coverage expansion models,” said Jack A. Meyer, Ph.D., founder and president of ESRI. “While many different proposals for expanding coverage have been put forward, the process of evaluating them has been inconsistent, impeding progress on the issue.”

The resource center also includes:

  • A description of California’s present health insurance system and five alternatives: expansion of Medi-Cal and Healthy Families, a simple tax credit, an enhanced tax credit with an individual mandate, a pay-or-play employer mandate, and a single payer approach;
  • A summary of trade-offs for each model;
  • An interactive quiz that tests users’ assumptions about which coverage models fit their values; and
  • A tool that allows users to compare side-by-side the attributes and trade-offs of the status quo and five alternative models.

According to Yegian, Meyer, and project manager Elliot Wicks of ESRI, while the project focuses on California, the resulting information and tools are equally valuable for other states considering coverage expansion or for assessing national proposals.

About the Economic and Social Research Institute

The Economic and Social Research Institute is a nonprofit, nonpartisan institute that conducts research and studies directed at enhancing the effectiveness of social programs, improving the way health care services are organized and delivered, and making quality health care accessible and affordable. Visit for more information.

About the California Health Care Foundation

The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.