A new study reveals that universal coverage can be achieved without a complete overhaul of the health system.
The United States could achieve near-universal coverage with moderate decreases in national health spending, even within the existing public-private healthcare system, according to reports recently published by the Urban Institute and the Commonwealth Fund.
The study, Comparing Health Insurance Reform Options: From “Building on the ACA” to Single Payer, analyzes eight healthcare reforms and their potential effects on insurance coverage, national healthcare costs and spending by federal and state governments, consumers and employers.
The plans fall along a continuum-from improvements to the ACA to a single-payer reform, similar to Medicare for All proposals, that would eliminate private insurance, cover all U.S. residents and undocumented immigrants and eliminate premiums and cost-sharing.
Many of the proposals analyzed are similar to reform packages and legislation advanced by Democratic presidential candidates and members of Congress.
Key findings include:
Under one of the plans modeled in the report, a mix of private and public health insurance, everyone in the U.S. could be covered except for some undocumented immigrants. The plan would enable workers to opt for subsidized nongroup coverage instead of their employer’s insurance plan. It also would improve the ACA’s subsidies to help people afford coverage, cover people in states that have not expanded Medicaid, require everyone to have insurance with an autoenrollment backup, offer a public insurance option and cap provider payment rates.
Coverage gains: Achieves universal coverage for people legally present in the U.S., covering 25.6 million people who would otherwise be uninsured. However, the plan leaves 6.6. million undocumented immigrants without coverage.
National spending: National spending on health care decreases modestly, by $22.6 billion or 0.6%, compared to current law in 2020.
Federal government spending: Spending increases by $122.1 billion in 2020, or $1.5 trillion over 10 years.
Linda Blumberg, PhD, of Urban Institute Fellow, says all health reform plans involve choices and tradeoffs.
“This report serves as a guidepost for measuring the potential effects of different reform proposals when it comes to covering the uninsured, improving the affordability of health care and the government funding required to implement them,” Blumberg says. “What’s clear is that each reform proposal makes health insurance considerably more affordable by lowering people’s premiums and cost-sharing. Some reforms also lower U.S. health care costs, and all require additional federal dollars to finance the reforms."
David Blumenthal, MD, Commonwealth Fund President, says good, affordable health insurance is essential to Americans’ well-being and financial security.
“This report is a reminder that there are many ways to get all Americans covered,” Blumenthal says. “As we enter the 2020 presidential campaign season in earnest, it’s critical that policymakers and the public understand how various health reform proposals will impact health care costs, household budgets and health insurance coverage.”