The Affordable Care Act (ACA) has substantially reduced the number of uninsured Americans, increased access to care, reduced uncompensated care for hospitals and other providers, and largely eliminated discrimination against the sick in private health insurance markets. Still, significant problems remain: 30 million people in the United States remain uninsured, while many others are underinsured--meaning they lack adequate financial protection against high health care costs. While many people have experienced lower costs after getting coverage through the ACA, others have found that premiums and cost-sharing requirements are still too high to participate. Following a Supreme Court decision that made Medicaid expansion optional for states, many poor adults in the 17 states that have yet to expand the program have been left without any financial assistance for coverage. Additional policy changes made by the Trump administration and Congress since early 2017 have created new problems and exacerbated others. During the 2020 presidential election season, plans for addressing these and other shortcomings will be central to candidates' campaigns and a focus of presidential debates. A uniform framework that compares coverage and cost implications of different proposals will help policymakers and citizens make more objective, thoughtful comparisons of the advantages and disadvantages of different policy options. In this report, we analyze eight health care reform packages intended to address shortcomings of the current health insurance system. We estimate their potential effects on health insurance coverage and spending by government, households, and employers. The packages represent an amalgam of ideas developed by policymakers, presidential candidates, and policy experts. Some would make fundamental changes to the structure of the U.S. health insurance system, while others would build on the existing system. Because new bills are regularly introduced and details of existing bills are likely to change, our work focuses on reform approaches rather than particular pieces of legislation.
Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY license. (More information)