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A look at the costs of eight healthcare reform proposals


The Commonwealth Fund compared eight different healthcare reform proposals

As the search for the 2020 Democratic presidential nominee continues and the country continues the long slog to the general election, health insurance reforms and what they will cost are taking an outsized role in the minds of many Americans.

A new study gives insight on the costs of eight different healthcare reforms from simply building on the Affordable Care Act (ACA) to a single-payer system which are designed to address the shortcomings of the country’s healthcare insurance system.

The study was released October 16 by The Commonwealth Fund and examines a continuum of reforms from less to more comprehensive by comparing them to both current healthcare costs and each other.

The eight reforms examined are:

·      ACA Enhanced I: Improves the act’s current premium and cost-sharing subsidies and adds reinsurance program for individual market to protect insurers against high claims

·      ACA Enhanced II: Above reforms plus restoration of the ACA’s individual mandate penalty and reversal of Trump administration’s expansion of short-term, limited-duration plans.

·      ACA Enhanced III: Builds on above reforms by closing the Medicaid eligibility gap for very low-income adults in states that have not expanded the program. Introduces limited autoenrollment for most people receiving Temporary Assistance for Needy Families or Supplemental Nutrition Assistance Program benefits.

·      ACA Enhanced IV: Adds a public plan option and/or capping of the provider payment rates in private nongroup insurance plans to the above reforms.

·      Universal Coverage I: Plan achieves universal coverage by building on the above reforms by enabling workers to opt for subsidized nongroup coverage instead of their employer’s plan and creating a way for all legal U.S. residents are deemed insured and features a public option in the nongroup market.

·      Universal Coverage II: Build on above reforms by boosting premium and cost-sharing subsidies even further.

·      Single Payer “Lite:” Single-payer plan covers all legal U.S. residents in the country including all the ACA’s “essential health benefits.” Cost-sharing for individuals pegged to income but no premiums and no private insurance option.

·      Single Payer Enhanced: Covers all U.S. residents including undocumented immigrants, featuring a broader set of benefits than Single Payer “Lite” including adult dental, vision, and hearing care along with home- and community-based long-term services and supports benefit which includes no cost-sharing requirement or private insurance option.

Overall, the researchers found that each option improve the affordability of health insurance through lower premiums and cost-sharing while broadening public program eligibility. Patient costs drop dramatically in the single-payer plans, but those plans find government spending and taxes increasing.


The authors of the study found that there are five issues they believe should be particularly important to consider when designing health insurance system reforms. They are:

·      Levels of provider payment rates

·      Phase-in period

·      Effects on employer healthcare spending and wages

·      Effects on household spending

·      Effects on total national health spending

The study also found that true universal coverage would require either an autoenrollment or a single-payer system that enrolls the entire population in a single plan.

Some other key discoveries of the study found that:

·      Under Universal Coverage I, an additional 25.6 million people would be insured leaving only 6.6 million undocumented immigrants without coverage while seeing a decrease of $22.6 billion or 0.6 percent in national healthcare spending. Overall, spending would increase by $122.1 billion in 2020, or $1.5 trillion over 10 years.

·      Under Single Payer Enhanced, everyone in the United States would be covered including undocumented immigrants and national spending on healthcare would grow to $720 billion in 2020 while federal government spending increases by $2.8 trillion in the same period. Over 10 years, federal government spending will top $34 trillion.

·      Single Payer “Lite” sees universal coverage for an additional 25.6 million uninsured people, but 10.8 million undocumented immigrants will be left without insurance. National spending on healthcare would drop by $209.5 billion or six percent in 2020. Federal government spending would increase to $1.5 trillion by next year and hit $17.6 trillion over 10 years.

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