Cost and Coverage: The Impact of Implementing Various State Health Care Reform Proposals Nationally. Introduction


With 45.7 million uninsured Americans in 2007, up from 38.4 million in 2000 (U.S. Census Bureau, 2008), health care reform is taking center stage as one of the top priorities for governors, state legislatures, and Congress.  In the absence of a cohesive and actionable national health care reform agenda, many states are exploring opportunities to reform their health care systems in order to expand coverage.  The Massachusetts health care reform effort is likely the most widely known, both because of the expansiveness and innovation involved, but many other states have considered and/or implemented less extensive and complex reforms as well.  States are trying, and in some cases succeeding, to reduce the ranks of the uninsured among their residents.  While health care reform may, indeed, occur one state at a time, transformation on a national scale should not be overlooked.

In this paper, we will present the findings of an analysis that explores the coverage and cost impacts of implementing various state health care reform proposals nationally.  While there is no shortage of ideas for how to expand coverage, the analysis was limited to looking at five different reform options:

  • A health insurance premium subsidy program,
  • An employer mandate to implement Section 125 plans,
  • An employer mandate to provide coverage,
  • An individual mandate to have coverage, and
  • A national implementation of certain combined features of the Massachusetts reform initiative.

For each of these options, we will discuss how a reform of this nature will affect both those who have coverage and those who do not, as well as the cost to Federal, state, and local stakeholders.

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