Covering the uninsured; interactions among public and private sector strategies

Article Abstract:

Medicaid is a Federal program which currently fails to provide medical health insurance to those 10.9 million uninsured individuals who live below the poverty line. There is current interest in closing gaps or inequities in the protection afforded individuals by the current plan. The costs associated with this expansion are explored and related to two proposed systems of providing this coverage: employer mandated expansion to the employed uninsured; and a Medicaid buy-in which would subsidize medical health insurance for the near-poor. The cost of expanding Medicaid enrollment to those uninsured individuals living at or near the poverty line and those holding nongroup policies would increase program costs by an estimated $22.9 billion, which in a buy-in plan would be offset by premiums of $4.5 billion. Overall the costs of expanding Medicaid could lie between $11.5 and $129.5 billion, depending on the final version of any legislation passed. The cost of mandated employer-provided insurance would significantly reduce the public cost of the provision of this insurance, but the impact would have a significant effect on the private sector. The grand picture involves an appropriate assignment of costs between public and private sectors to provide basic health coverage to the nations' poor. Any implementation must consider the profound interplay between public and private sectors, since costs could dramatically shift based on the perceived value provided by competing private and public plans. In part the implementation of a comprehensive plan depends on the evaluation of the proper role of employers in providing health insurance for their employees and families. Such a social determination affects over 24 million uninsured individuals who are somehow connected to the work force. In part legislation will have to decide whether the poor and near poor are included in a public safety net provided by either by Medicaid alone or as a component of a broader employment-based insurance plan.

Social aspects, Analysis

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Including the poor: the fiscal impacts of medicaid expansion

Article Abstract:

It is estimated that 37 million Americans are excluded from health insurance and that approximately 10.9 million have incomes below the poverty line. Recently, the Health Policy Agenda for the American People, a group formed by a coalition of 172 other public groups, focused their attention on Medicaid. The recommendations of this group included the following important points: break the link between public assistance and Medicaid eligibility by setting a simple financial standard; develop a standard benefit package that would eliminate different benefits between states; and establish financial incentives to interest health-care providers to expand their coverage. The cost of making health care nearly universal is considered by estimating the cost to cover all individuals below the poverty line (approximately $9 billion), developing a standard benefit package ($19 billion) and providing reimbursement to physicians and other providers of health-care services at competitive market rates ($4.4 to 5.5 billion). Provision of increased medical benefits to those living at or below the poverty line would also reduce spending by these individuals by approximately $2.5 billion.

Planning, Economic aspects, Medical care, Cost of, Health care costs, National health insurance, Health Policy Agenda for the American People

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Incremental strategies for providing health insurance for the uninsured: projected federal costs and number of newly insured

Article Abstract:

Several strategies to provide health insurance to the uninsured are discussed. In 1995, about 40 million people were uninsured, 10.5 million of whom were children. More children could be enrolled in Medicaid or their parents could be given financial incentives to buy insurance. Workers and their families could buy coverage when they are between jobs. The estimated cost of these programs ranges from $2 billion to $7 billion per year and 7 million uninsured Americans would be insured. These programs could be funded by savings in the Medicaid program or a cigarette tax. The government could also cut back on Medicare/Medicaid payments to hospitals.

Innovations, Insurance

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