Options and opportunities for individuals and families in the private health insurance market.
(17/39)
A variety of options exist for coverage in the individual health insurance market. Coverage is state-regulated; this provides consumers with important access and benefit protection and ensures stability of insurers. Coverage for individuals is based on health history in most states, and most individuals either qualify for coverage or are able to find it through state high-risk pools and other state mechanisms. Since individual-market purchasers do not have an employer contribution to offset the cost of coverage, proposals for refundable tax credits offer great potential for making health insurance coverage more affordable for eligible persons. (+info)
Creating consensus on coverage choices.
(18/39)
The framework for reaching near-universal coverage outlined in this paper combines tax credits for private insurance and public program expansions. It illustrates how a series of incremental steps could be phased in to achieve near-universal coverage. Hallmarks include creation of a Congressional Health Plan; use of the income tax system to provide tax credits and enroll uninsured people; creation of a state Family Health Insurance Program open to everyone below 150 percent of poverty; and creation of a Medicare Part E, open to the disabled and uninsured older adults. The paper provides coverage and cost estimates and identifies potential sources of revenue to finance coverage. (+info)
A relevant universal coverage proposal.
(19/39)
Karen Davis and Cathy Schoen offer a strategic vision for universal coverage that attempts to move beyond ideological battles that have stifled progress. However, I believe that there are a few specific shortcomings with the proposal's logic that could thwart political consensus. I review some of these shortcomings and make suggestions for incremental technical improvements. In particular, I suggest that future versions of the proposal consider administering the tax credits as a "passthrough" from the government through employers to individuals. I also believe that reform proposals should address more directly the issues of provider accountability and patient information needs. (+info)
Use of subsidies to low-income people for coverage through small employers.
(20/39)
If tax credits or other public subsidies are made available only for health insurance that is not employment-based, serious erosion of employer coverage could result. To prevent this, public subsidies targeted to low-income workers and families could be applied in ways that broaden employer coverage for low-income workers and their families by encouraging small employers with largely low-wage workforces to offer and partially fund health coverage for their workers. To accomplish this, such employers--very few of which now provide health coverage--must be allowed to contribute much less than normally required in the commercial market. (+info)
The effect of tax credits for nongroup insurance on health spending by the uninsured.
(21/39)
We compare out-of-pocket spending for health care by lower-income uninsured people with their net spending on insurance and health care if they took up each of three hypothetical tax credits. Because of nongroup policies' high cost and low benefits, nearly all would spend more, often much more, under a tax credit similar to that proposed by the Bush administration. When viewed in the context of other research on low-income people's demand for health insurance, the results suggest that sizable reductions in the number of uninsured will require more generous tax credits than those in current proposals. (+info)
The cost of tax-exempt health benefits in 2004.
(22/39)
The tax expenditure for health benefits is the amount of revenues that the federal government forgoes by exempting health benefits and spending from the federal income and Social Security taxes, including (1) employer health benefit contributions for workers and retirees, (2) health benefit deductions for the self-employed, (3) health spending under flexible spending plans, and (4) the tax deduction for health expenses. We estimate that this expenditure will be dollars 188.5 billion in 2004. Families with incomes of dollars 100,000 or more (14 percent of the population) account for 26.7 percent of all health benefit tax expenditures. (+info)
Profit-seeking, corporate control, and the trustworthiness of health care organizations: assessments of health plan performance by their affiliated physicians.
(23/39)
OBJECTIVE: To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. DATA SOURCE: A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. STUDY DESIGN: Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. DATA COLLECTION: The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. PRINCIPAL FINDINGS: Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for-profit corporate plans on four of five outcomes, but appear less trustworthy than locally controlled nonprofits on two of the five measures. The magnitude of these ownership-related differences declines as the market share of nonprofit plans rises: for two of the five measures, ownership-related differences in practices related to trustworthiness are entirely eliminated when the nonprofits enroll more than 30 percent of the local market. CONCLUSIONS: The combination of for-profit ownership and multistate corporate control appears to consistently and substantially reduce physician-reported measures related to the trustworthiness of health plans. Because this is the fastest growing form of managed care, these results raise concerns about further erosion of trust in American health care. Preserving a substantial market niche for nonprofit plans appears to reduce this erosion and should be considered by policymakers as a strategy for restoring trust in the health care system. (+info)
How nonprofits matter in American medicine, and what to do about it.
(24/39)
Skeptics question nonprofit health care on the grounds that nonprofits fail to distinguish themselves from their for-profit counterparts and do not reliably provide community benefits commensurate with their tax subsidies. Drawing on the most recent and comprehensive evidence, we assess these charges, judging them to be either wrong or incomplete. Although conventional critiques are therefore unconvincing, there are nonetheless important challenges facing the nonprofit sector in American medicine. To address these, we propose reformulating ownership-related policies to define both the appropriate forms of community benefit and the appropriate mix of ownership in terms of local markets and communities. (+info)