COD E R E D

etween $23 and $120 per month. There are no co-payments for primary and preventive careservices, nor for hospital-based services. Physician visits, pharmaceuticals and emergencydepartment visits require nominal co-payments.In addition, Alliance Family Care enrollees choose a primary care provider located atone of the participating care sites. Specialty care is covered but, as is typical in the safety netsystem, is often difficult to access.FinancingThrough a combination of private and public funds, the Alliance is able to subsidize carefor Alliance Family Care enrollees, thereby keeping cost-sharing at a more affordable level. Thebulk of the funding comes from the Alliance itself, which provides almost $15 million out of itsreserve funds. Grants from the California Healthcare Foundation ($1 million), The CaliforniaEndowment ($400,000) and the county tobacco settlement fund ($2 million) provide the balanceof funding. Another $950,000 is pending. The Alliance used funding from the W.K. KelloggFoundation’s Community Voices Initiative to support a Family Care evaluation. Finally, a countywideenrollee satisfaction survey was conducted, for which the Community Voices grantprovided $50,000 and in-kind staff time for management and oversight.HealthPass xxxiii,xxxiv,xxxvNew York, New YorkOverviewIn 1999, New York City Mayor’s Office and the New York Business Group on Health(NYBGH) developed HealthPass, a health insurance cooperative for small businesses.HealthPass is administered by the New York Health Purchasing Alliance, a subsidiary ofNYBGH, and provides access to a range of health plans and prescription drug and dentaloptions. The cooperative does not provide premium subsidies, but does offer small businessesa rare combination of choice and administrative simplicity. It utilizes the “defined contribution”approach, in which employers pay a set amount of each employee’s premium and employeescan choose more expensive plans and pay the balance themselves. Hence while there is nosubstantial price advantage relative to the regular market as a consequence of joiningHealthPass, the cooperative makes shopping for health insurance relatively simple and providesmany health benefit choices to employees.HealthPass is considered to be a relatively successful cooperative not only because ofthe administrative simplicity it provides and the flexible benefit plans it offers, but also becauseof the initial support it received from local government and its close ties to the brokercommunity. The New York City Mayor’s Office contributed money to HealthPass during itsstart-up phase and lent personnel to assist in managing the cooperative. The cooperative’sclose interaction with the broker community has also benefited HealthPass as brokers havebeen the main source of enrollment. HealthPass’ major drawback has been its inability toachieve financial self-sufficiency as of 2004.D-24