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Covering the Uninsured: Options for Reform

Covering the Uninsured: Options for Reform. Alliance for Health Reform Briefing March 2, 2009 Jack Ebeler. Overview. Purpose: provide simple, top-line overview of approaches to coverage Source for presentation: Approaches for Covering the Uninsured: A Guide

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Covering the Uninsured: Options for Reform

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  1. Covering the Uninsured: Options for Reform Alliance for Health Reform Briefing March 2, 2009 Jack Ebeler

  2. Overview Purpose: provide simple, top-line overview of approaches to coverage Source for presentation: Approaches for Covering the Uninsured: A Guide by Jennifer Tolbert, Jack Ebeler, Tanya Schwartz Kaiser Commission on Medicaid and the Uninsured http://www.kff.org/uninsured/upload/7795.pdf December 2008 Note: purpose was to address coverage: did not deal with cost, quality, other issues

  3. Sources of health insurance coverage, individuals under age 65, by family income, 2007 As family income increases, the likelihood of: • Employment-based coverage increases • Public coverage decreases • Individual coverage is fairly constant • Being uninsured decreases Note: over 65 not on chart; essentially all are in Medicare

  4. Overview • Overall approaches • Build on current financing approaches • Substantially replace current approaches • Within either, attend to access to and affordability of coverage • Mix and match from menu

  5. Overall: strengthen/build on current approaches Overall approaches • Employment-based coverage: • Employer mandate – require employer to offer/subsidize • “Pay or play” – require employer to offer/subsidize, or pay to pool to finance alternative coverage source • Public coverage: • Expand Medicaid/CHIP enrollment, and/or eligibility • Medicare for those age 55-64 • Subsidize benefits for temporarily unemployed • Individual coverage: revise regulatory approaches Individual mandate option w/in any of these arrangements

  6. Overall: substantially replace current financing and tax subsidies • Single payor (eg, Medicare for all) • Redirect tax subsidy away from employment-based coverage and provide directly to individuals: tax credits for individual market

  7. Availability/affordability/subsidy approaches within overall framework Affordability/subsidies • Subsidies (tax, other) for individuals and/or employers • Offer/encourage products with less expensive premiums (high deductible) • Young adult plans • Reinsurance Availability of products/market organization • Access to/organization of larger purchasing pools (eg., connector; FEHB) • Medicare-like plan available as an option • Association health plans • High risk pools

  8. Mix and match If Congress does not go for one “pure” model, multiple combinations possible – can mix and match from the menu: • McCain • Obama campaign • Baucus • Wyden • And…

  9. Thank you

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