By Joanna Anderson, CQ Staff
October 18, 2007 -- Health care overhaul that incorporates both private and public insurance is the best approach to achieve universal coverage, according to a report released Thursday by The Commonwealth Fund Commission.
The report endorses the mixed approach to address the increasing number of uninsured Americans, as opposed to implementing either a solely private or public system.
"Health insurance reform plans that build on a mix of private and public health insurance, where costs are shared among government, employers, and enrollees, would have great potential to move the system to high performance and would be the most practical to implement," the report found.
The report found a mixed approach would minimize federal budget outlays and dislocation of patients by allowing individuals with employer-based coverage to retain the insurance if they met certain benefit and affordability standards. Such an approach also would address the shortcomings of the current system, such as "gaps in coverage and the absence of the incentives, organization, and infrastructure required for a high performance health system," the report found.
The analysis noted the mixed universal coverage plans that have been enacted in Massachusetts and proposed by California Republican Gov. Arnold Schwarzenegger and Democratic presidential hopefuls Gov. Bill Richardson of New Mexico, former Sen. John Edwards of North Carolina, as well as Sens. Hillary Rodham Clinton of New York, Christopher J. Dodd of Connecticut, and Barack Obama of Illinois. Most of these plans include expansions in Medicaid and the State Children's Health Insurance Program, as well as "new group insurance options with financial support for premiums and out-of-pocket expenses for lower- and middle-income households" designed to fill coverage gaps.
The report also noted the proposals offered by President Bush and GOP presidential candidates Sen. John McCain of Arizona, former New York Mayor Rudy Giuliani, and former Gov. Mitt Romney of Massachusetts that comprise private plans that "would create tax incentives for people to gain coverage through the individual insurance market." Those plans, however, are "unlikely to achieve universal coverage" if not coupled with other changes, according to the analysis.
Public plans, meanwhile, would "offer the greatest potential for automatic and continuous enrollment and the ability to cover everyone" and move the health care system toward high performance, the report said. However, such plans would create dislocation and be financed largely by "federal income and payroll taxes or new taxes, such as a value-added tax or consumption tax."
Dallas Salisbury, president and CEO of the Employee Benefit Research Institute and chairman of the Commission's Coverage Workgroup, said "The most important takeaway of this report is that universal coverage is essential to improve access, quality, equity, and efficiency in the U.S. health care system."
