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Report Examines Prospects for Universal Coverage

By CQ Staff

April 6, 2007 -- After years of wrestling with how to provide health care coverage to millions of Americans who do not have it, policymakers and politicians may be coming to a consensus around proposals requiring most Americans to buy private insurance with public assistance.

A CQ Researcher report published March 30 details how state governors in California and Massachusetts back such plans, as does former Sen. John Edwards, the first presidential hopeful to announce a universal coverage proposal as part of the coming 2008 election.

Approximately 45 million Americans—about 15.3 percent of the population—lack health insurance, usually due to job loss, student status, early retirement, or because they have entry-level jobs or work in a service industry or in a small business that does not provide health insurance.

Rising health care costs may cause more Americans to become uninsured, putting even more pressure on the federal and state governments to finds ways to provide coverage to those who do not have it. If health premiums continue rising at their current rate, about 56 million Americans are predicted to be uninsured by 2013—11 million more than today, according to a University of California at San Diego study.

A major obstacle to providing universal health coverage is funding. Among thorny financial issues are questions over who is going to pay for the coverage, how can affordable access be ensured for all, and how overall health care costs can be reduced.

Options for financing include asking employers to contribute to a general pool, with the amount varying by companies' line of business and geographical location. Some lawmakers have advocated tax subsidies to help individuals purchase their own coverage rather than having it tied to their place of employment, though purchasing health care coverage in the individual market can be difficult and expensive.

Noting such difficulties, analysts say that regardless of whether they succeed completely, state initiatives provide models and impetus for future national efforts and may help break the political gridlock that has stopped Congress from acting on the issue.

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