Individuals with Special Needs and Health Reform: Adequacy of Health Insurance Coverage

Kaiser Commission on Medicaid and the Uninsured

September 10, 2009

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This issue brief examines the health care needs and health costs of individuals with special health challenges, focusing on those with low-to-moderate incomes. It finds that even under a benefit package more generous than most offered in the private insurance market, individuals and families can face significant gaps in coverage and large out-of-pocket costs, especially if they have serious health conditions.

The findings have implications for the health reform debate as policymakers consider minimum standards for coverage, required cost sharing amounts and limits on covered benefits in health plans.