SHADAC Issue Brief #20 addresses the history of state high-risk pools, provides information on individual state high-risk pools, states’ decisions about participation in the temporary high-risk pool created by national health reform, and concerns about the transition from state high-risk pools to guaranteed issue in the individual market.

Presentation by Lynn A. Blewett to the Minnesota Health Care Reform Review Council at the Minnesota Department of Revenue, St. Paul, MN, June 18 2009.

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This SHADAC student paper provides an overview of the safety net through a comprehensive literature review, focusing specifically on how the safety net is defined, including its providers, recipients, funding sources, and measures. April 2003.

Davidoff, M. J. , E. Ulrich, P. Carrizales, and L. A. Blewett. “Improving Health Care Access for Minnesota’s Growing Latino Community” in Just in Time Research: Resilient Communities. Report # BU-7565. Minneapolis: University of Minnesota Hubert H. Humphrey Institute of Public Affairs and University of Minnesota Extension Service.

MinnesotaCare has been a successful policy tool to increase access to health insurance for the uninsured, yet it is not as successful in meeting the unique needs of immigrant communities. This paper presents specific policy recommendations designed to increase access to health care for Latinos in Minnesota and describes the successful collaborative community-based research effort that was used to develop these recommendations.

Taylor, P., L. A. Blewett, M. Brasure, E. Larson, J. Gale, A. Hagopian, G. Hart, D. Hartley, P. House, M. K. James, and T. Ricketts. 2003. “Small Town Health Care Safety Nets' Report on a Pilot Study.” Journal of Rural Health 19 (2): 125-134.

CONTEXT: Very little is known about the health care safety net in small towns, especially in towns where there is no publicly subsidized safety-net health care. PURPOSE: This pilot study of the primary care safety net in 7 such communities was conducted to start building knowledge about the rural safety net. METHODS: Interviews were conducted and secondary data collected to assess the community need for safety-net care, the health care safety-net role of public officials, and the availability of safety-net care at private primary care practices and its financial impact on these practices. FINDINGS: An estimated 20% to 40% of the people in these communities were inadequately insured and needed access to affordable health care, and private primary care practices in most towns played an important role in making primary care available to them. Most of the physician practices were owned or subsidized by a hospital or regional network, though not explicitly to provide charity care. It is likely this ownership or support enabled the practices to sustain a higher level of charity care than would have been possible otherwise. In the majority of communities studied, the leading public officials played no role in ensuring access to safety-net care. CONCLUSIONS: State and national government policy makers should consider subsidy programs for private primary care practices that attempt to meet the needs of the inadequately insured in the many rural communities where no publicly subsidized primary safety-net care is available. Subsidies should be directed to physicians in primary care shortage areas who provide safety-net care; this will improve safety-net access and, at the same time, improve physician retention by bolstering physician incomes. Options include enhanced Medicare physician bonuses and grants or tax credits to support income-related sliding fee scales.