New York City, April 23, 2003—An innovative framework to provide automatic, affordable health insurance to nearly all Americans is outlined today in a Web-published Health Affairs article by health policy experts Karen Davis and Cathy Schoen of The Commonwealth Fund. The article, "Creating Consensus on Coverage Choices," would build on existing sources of public and private health coverage by combining tax credits for private insurance, public program expansions, and a new mechanism to make enrollment more automatic. The article also provides a roadmap for a phased-in series of steps to achieve affordable and automatic coverage for all Americans over time. The framework presented by Davis and Schoen seeks to bridge differences between those policy strategies that rely on tax credits to increase private insurance coverage and those strategies that would increase health coverage through public program expansions. An estimated 39 million of the 42 million Americans who are uninsured would gain coverage, increasing total national health expenditures by a modest 3 percent. "We know what works in the current system, so we should build on success instead of trying to reinvent the wheel," said Davis, president of The Commonwealth Fund. "The consensus approach gives people the choice to keep the coverage they have if it's working well for them. It provides a long-term vision, but also lends itself to phasing in and adjustment over time with experience. The federal government could begin to enact some pieces of this plan immediately." Key aspects of the consensus framework include:
- Access to affordable coverage for small-business employees, the self-employed, and other uninsured individuals through a new Congressional Health Plan. The Congressional Health Plan would provide a choice of any insurance plan participating in the Federal Employees Health Benefits Program (FEHBP). It would be open to anyone working for a business that has fewer than 50 employees, as well as to self-employed workers and other uninsured individuals.
- Automatic enrollment and premium assistance. Any uninsured person would receive tax credits to help pay premiums that exceed 5 percent of their incomes (10 percent for those in upper tax brackets). The uninsured would be enrolled automatically in the Congressional Health Plan and would have a choice of other group options.
- Public coverage expansions for low-income individuals and people at risk for being uninsured because of their health or age. Medicare would be open to those 60 and older who lack access to group coverage, to the disabled on the Medicare waiting list, and to Medicare dependents. State-run programs, with enhanced federal financing to reduce state costs, would be open to any individual or family with an income below 150 percent of poverty.
- Building on employer-sponsored coverage where it is working well. To minimize disruptions in coverage, employers would continue to be the mainstay of the health insurance system for working families. Companies that do not offer coverage to employees would contribute 5 percent of payroll--up to $1 per hour worked--to a fund that would help pay for coverage.