Funded by the California HealthCare Foundation, the Institute for Health Policy Solutions' Washington, DC team recently led an effort that also included RAND and Actuarial Research Corporation to examine the policy and implementation implications of SB 2, The California Health Insurance Act of 2003. Passed and signed into law in 2003, then subsequently overturned by Proposition 72 in the 2004 general election, SB 2 was a “Pay-or-Play” employer mandate. Had it survived and been implemented, medium-sized and large employers would have been required to either provide health insurance directly to their employees, or pay into a state pool which would be used to provide coverage.

A key focus of the study was intended to be program policies and administrative issues related to viability of the state purchasing pool established under SB2, particularly for the Managed Risk Medical Insurance Board (MRMIB), which would have been charged with operating the pool. Following the passage of Proposition 72, the project was revised to put more emphasis on alternative design scenarios and their implications, and less on implementation details. As a result, much of the analysis here can help inform a range of approaches to sustainable coverage expansions involving one or more key features of SB2: employer-financed coverage; health insurance purchasing pools; premium subsidies for low-income populations; and/or individual mandates.

Available below in PDF form are the full report, an executive summary of the report findings and the report supplements. An issue brief summarizing the findings and examining the implications of pay or play coverage expansion strategies will be available later in 2005.

Challenges and Alternatives for Employer Pay-or-Play Program Design: Full Report, pdf

Challenges and Alternatives for Employer Pay-or-Play Program Design:
Executive Summary, pdf

Supplement A: Simulation Results, pdf
Supplement B: Benefit Design, pdf
Supplement C: Cost Management, pdf
Supplement D: ERISA, pdf
Supplement E: Risk Adjustment, pdf
Supplement F: Quality, pdf
Supplement G: Stakeholders, pdf
Supplement H: Database Development, pdf
Supplement I: Simulation Model, pdf


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