The current congressional debate about health reform focuses on two closely linked issues: how to structure subsidies and the future of Medicaid. We write to support two propositions that can better serve economically vulnerable families, while also ensuring that public dollars are spent effectively. First, we believe public subsidies for private insurance premiums should be means-adjusted to make coverage affordable for lower-income people. Second, we believe states should be given new flexibility to streamline coverage options in Medicaid, the Children’s Health Insurance Program (CHIP) and other publicly supported insurance, so that families can obtain the coverage that best suits their circumstances and serves their needs.

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