Below are brief summaries of Grant Results Reports available on past grantmaking in this field of interest. In some cases, the grants were made before the team decided on its current strategic objective. Findings and lessons from the grants described have nonetheless informed RWJF’s grantmaking. Visit the Foundation’s Web site www.rwjf.org for more Grant Results Reports.

Ensuring Older Workers and Retirees Have Health Coverage and Income
The National Academy of Social Insurance held conferences, seminars and workshops in which representatives from the insurance industry, employers, policy-makers and consumers discussed how to ensure health and income security for an aging workforce. They reviewed the effects of declining workers’ compensation payments, cutbacks in retiree health benefits provided by employers, disability injuries and claims by older workers, and how the financial burden for health care shifts among Medicare, Medicaid, private insurance and consumers based on different scenarios. Participants proposed pursuing two goals simultaneously: increase opportunities for older workers (ages 50 to 70) to retire later; and ensure health coverage and income continuity for people who cannot work longer. The researchers published a book, “Ensuring Health and Income Security for an Aging Workforce.” See the Grant Results Report at www.rwjf.org/reports/grr/036622.htm.

Shifting Private Insurers’ Risk to Government Could Make Health Insurance More Affordable
Katherine B. Swartz, Ph.D., Harvard University, studied markets for people buying their own health insurance and found that the high cost is an obstacle for both the two-thirds of the uninsured who are poor and need government subsidies and the one-third who are middle class and could obtain health insurance if it cost less. Insurers tend to charge higher premiums for individuals and small groups to screen out high-risk applicants because they fear adverse selection, which occurs when a disproportionate share of people buying individual insurance know they have medical problems or need expensive medical care. A 1996–97 survey showed 2 percent of the population incurs 39 percent of medical expenses. Swartz examined mechanisms that would shift the risk of adverse selection from individual carriers to a larger portion of the population and found that the most workable public policy solution is to have the government act as reinsurer for high medical expenses for insurers in the individual market. Premiums for individual policies would fall substantially and would be more affordable for greater numbers of people, especially the growing number of uninsured middle-class people. See the Grant Results Report at www.rwjf.org/portfolios/resources/grantsreport.jsp?filename=033818.htm.

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