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 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

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

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

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

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

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

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…

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