Health Insurance

In this report the authors estimate that under the health reform bill passed by the Senate, the cost of uncompensated care will fall from $62.1 billion in 2009 to $46.6 billion in 2019. If no health reform is enacted, they project that uncompensated care would rise to between $107 and $141 billion in 2019. Over the six-year period of proposed health reform legislation, 2014–2019, the costs of uncompensated care without health reform would be between $560 and $700 billion. With reform, the cost would be $330 billion under the Senate bill and provide substantive savings to each level of government.

Building on the American Recovery and Reinvestment Act of 2009, health reform legislation would develop an infrastructure for the ongoing generation and dissemination of information on the comparative effectiveness, where "comparative effectiveness" has been defined as the study of methods to prevent, diagnoses, treat, and monitor A clinical condition or improve delivery of care to assist consumers, clinicians, purchasers, and policy makers to make informed decisions to improve health care at both individual and population levels. The issue brief explores the concept and describes areas of controversy that need to be addressed to make comparative effectiveness research successful.

This brief describes the groups with the most to lose if comprehensive health care reform is not enacted—people who either lack coverage today or who are required to pay the most for health insurance and medical care. These include the self-employed, those working for small employers, those with health problems, older working-age adults and early retirees, the low-incomes, and others without access to employer-based insurance. Reform's combination of Medicaid expansions, subsidies for exchange-based coverage, broader-based sharing of risk, and administrative economies of scale would make meaningful coverage affordable for the vast majority of individuals disadvantaged by the current system.

Many low-income workers would be prevented from accessing subsidies under current health reform proposals if they are offered employer-sponsored health insurance (ESI). This report examines the effectiveness of two employee choice voucher options in making health care more affordable for such families. Findings show that employee choice vouchers would make health coverage dramatically more affordable for the low-income families who take advantage of them, would increase insurance coverage very modestly, and would not significantly change government or employer spending. The voucher programs considered would modestly reduce the number of people covered by ESI while having little effect on premiums.

The Cato Institute recently released a study of health reform in Massachusetts by Aaron Yelowitz and Michael F. Cannon, entitled "The Massachusetts Health Plan: Much Pain, Little Gain." That study reports fewer gains in health insurance coverage and higher costs than have been reported by earlier studies. As the Urban Institute has done a substantial amount of research on health reform in Massachusetts, we have received a number of requests to reconcile the findings on health insurance coverage from the Cato study with the findings from earlier work. This paper is a response to those requests.