Covering California’s Uninsured: Three Practical Options
By Rick Curtis and Ed Neuschler
California HealthCare Foundation
October 2006
The alternative mandatory coverage models analyzed in this report include:
* An individual mandate with no required contribution by employers.
* An individual mandate with a “pay-or-pay-plus” requirement on employers, including a modest employer-contribution floor for full-time permanent workers and a required employer fee for other workers and their dependents.
* An All-Consumer Choice Exchange (ACE) funded by payroll fees on all employers and workers (an insurance exchange of competing health plans).
All of the alternative mandatory-coverage approaches estimated in this project would, to the extent that they were sustainable, both preclude people from becoming uninsured and ensure that modest- and low-income people could afford coverage. We have no research basis for estimating different growth rates for health care spending under the different alternatives we analyzed. But unless the disproportionate increases in health care costs are curtailed, a growing number of people with higher incomes will not be able to afford coverage without subsidies, and government’s ability to finance adequate subsidies for even the initial low-income population will falter.
http://www.chcf.org/topics/healthinsurance/index.cfm?itemID=125690
Executive Summary:
http://www.chcf.org/documents/insurance/CoveringCaliforniasUninsuredExecSummary.pdf
Full Report:
http://www.chcf.org/documents/insurance/CoveringCaliforniasUninsuredFull%20Report.pdf
Comment:
By Don McCanne, MD
California HealthCare Foundation (CHCF) was established to serve the citizens of California by helping to improve California’s health care financing and delivery systems. It was funded with a largely-coerced contribution from Blue Cross of California which represented accrual of tax benefits rightly reverting to the citizens once Blue Cross was converted to a for-profit, investor owned company. Mark Smith, MD, MBA (Wharton) has been its president and CEO since its founding in 1996. He has been a strong supporter of managed care and private insurance, while also having expressed his opposition to single payer reform.
California is ripe for comprehensive reform. There is strong support for the single payer model with a bill having recently been passed by the state legislature, only to be vetoed by Gov. Schwarzenegger. The governor has promised to introduce his plan for reform in January.
This background makes it easier to understand why CHCF is presenting three models of reform, each of which dramatically expands the private insurance market in California, as if these were the only feasible options available.
These options, as described in the report, fail to achieve the efficiencies, comprehensiveness, cost containment, and equity of the single payer model.
The gold standard of single payer needs to be included in every dialogue on reform, not only in California, but throughout the nation. Please continue to do your part to be sure that it is.