Medicaid

This report assesses the changes in coverage patterns and health care costs that will occur nationally if major reforms are not enacted. The authors find that by 2015, there could be 59.7 million people uninsured. The number could swell to 67.6 million by 2020, up from an estimated 49.4 million in 2010. As premiums nearly double, employees in small firms would see offers of health insurance almost cut in half, dropping from 41 percent of firms offering insurance in 2010 to 23 percent in 2020. Individual spending could jump 34 percent by 2015 and 79 percent by 2020.

It’s not exactly news — to Congress, the White House, and now many outside of elite circles — that the federal budget is out of control. Social Security, Medicare, and Medicaid make up more than 40 percent of spending other than interest during a normal year and all are growing faster than the economy and tax revenues. Yet, Congress has kept the overall tax burden remarkably constant as a share of gross domestic product for most of the past 50 years. Together, these factors lead to sky-high deficits, an exploding national debt, and the specter of economic collapse.

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.

Institute Fellow Rudy Penner describes how the U.S. budget is prepared by the executive branch and Congress, and how it then is implemented by the executive branch. The budget preparation process could be improved, Penner asserts, but budget implementation works smoothly and efficiently. The severe long-run budget problem the country faces is caused by only three spending programs: Social Security, Medicare, and Medicaid. All are growing faster than the economy, and there is strong opposition against raising tax burdens. Changes are suggested for the budget process so that it is better suited for dealing with this long-run problem.

In his State of the Union address, President Obama no doubt will promise to attack the deficit. Trouble is, the deficit is only a symptom of a chronic disease that strikes at the very heart of democratic government. The disease? Fiscal sclerosis — setting future national priorities in stone long before the future has arrived. Our fiscal arteries are so clogged and hardened that to do anything new, meet any emergency, or engage any new opportunity, the president must renege on past legislators' promises. If he doesn't address unsustainable promises head on, government will be tied up with yesterday's problems and the demands of yesterday's voters.