The U.S. has a number of options for getting to universal healthcare coverage — or nearly reaching that status — but each of those plans come with trade-offs that must be considered before heading down any path to reform, analysts from the Urban Institute and The Commonwealth Fund said in a new report.
The report published shortly after 12 Democratic presidential candidates argued at their fourth primary debate about what approach the nation should take in making healthcare in the U.S. more accessible and affordable for all Americans.
Former Vice President Joe Biden and Sen. Elizabeth Warren
The report also followed the results of a new survey by the nonpartisan Kaiser Family Foundation, which revealed that more Americans trust Democrats over Republicans for handling healthcare in the U.S.
In outlining eight different options for reforming the way Americans are covered, the authors of the Urban Institute-Commonwealth Fund report emphasized their ideas did not subscribe to any particular presidential candidates' or lawmakers' views or replicate any of their proposals, though the analysts acknowledged there were a number of similarities in the schemes they laid out and the approaches put forward by some Democrats and Republicans.
The report is intended to help voters and policymakers understand the facts about what the range of reform proposals might mean for Americans and the U.S. health system and what financing trade-offs might be required to implement them, said Sara Collins, vice president of healthcare coverage and access at The Commonwealth Fund.
"The idea was not to model the exact parameters of proposals, but to select a range of policy options that are similar to the approaches under debate, and therefore, illustrative of what their potential effects might be," Collins told reporters during an Oct. 15 briefing. "Our hope is that this extensive analysis will clarify for voters and policymakers the implications of the policy choices before us."
The report's authors said the analysis was intended to stand as a guidepost and a uniform framework for comparing the coverage and cost implications of the different proposals and would help Americans and policymakers make more objective, thoughtful comparisons of the advantages and disadvantages of the various policy options.
They emphasized there are a number of critical questions that must be addressed by the 2020 presidential candidates and policymakers on Capitol Hill about the various proposals, such as how much providers would be paid, how long it would take for the reforms to be implemented, how employer and household healthcare spending and wages would be affected and what the effects would be on national costs.
The eight proposals the authors outlined in their report ranged from a set of incremental improvements to the Affordable Care Act to a single-payer plan similar to the "Medicare for All" bills sponsored by presidential contenders Sens. Bernie Sanders, I-Vt., and Elizabeth Warren, D-Mass., and by Reps. Pramila Jayapal, D-Wash., and Debbie Dingell, D-Mich.
Sen. Bernie Sanders
The first four options would expand premium and cost-sharing subsidies and the eligibility criteria for Americans who enroll in plans offered on the ACA marketplace. They would also cap ACA plan premiums at the lower percent of income — 0% to 8.5%. Under those approaches, there would be a permanent reinsurance program for insurers in the individual market.
The gap in Medicaid coverage would also be closed for states that did not expand the program under the ACA. There would also be a public option available.
In addition, the ACA's individual mandate requiring Americans that meet certain financial criteria to buy health insurance or pay a tax penalty would also be restored.
The fifth option outlined by the Urban Institute-Commonwealth Fund authors would build on the other four by enabling workers to opt for subsidized nongroup coverage instead of their employer's insurance plan. It would also introduce a mechanism through which all legal U.S. residents are deemed insured.
The authors of the report said former Vice President Joe Biden's healthcare plan resembles a mix of the fourth and fifth options.
The sixth approach builds on the fifth option by boosting premium and cost-sharing subsidies even further.
The other two proposals are both single-payer plans — one deemed "lite" and the other "enhanced."
Both single-payer options would do away with private insurance policies. The single-payer lite approach would cover all legal U.S. residents and include all the ACA's 10 essential health benefits, with income-related cost-sharing.
The single-payer enhanced option would cover all U.S. residents, provide additional benefits beyond the ACA and have no cost-sharing.
At the Oct. 15 Democratic debate, Warren came under the most fire for not being up front about the costs of adopting a single-payer system.
Sen. Amy Klobuchar, D-Minn., whose health plan mirrors Biden's — though she unveiled hers first — implied Medicare for All was too much of a "pipe dream."