Payment Plans & Issues

The employer-based healthcare system has existed in America since World War II and is considered by many to be the bedrock of the nation’s health insurance system. To shore up this system and to extend coverage for those not currently insured, numerous health policy experts have argued for an “employer mandate” requiring employers to contribute to coverage for their workers.

Researchers from the Urban Institute review some of the key problems facing purchasers of insurance—whether they be individuals or employers—and outline whether and how a public health insurance exchange might address them.

With federal health reform potentially on the horizon, state governments will face new opportunities and challenges to improve local health care delivery systems—and ultimately, the health status of their residents. Exploring the effects of health reform on states is essential, as states play critical roles in financing, organizing, and regulating local health care systems.

This brief lays out who could enroll, who could receive subsidies and the anticipated impact on health insurance premiums, in addition to exploring the arguments for and against a public plan.

How different proposals stack up in terms of broadening coverage for individuals and small businesses, and their potential impact on the country.

"Single-payer" approach. All legal residents covered by Medicare, with expanded and rationalized benefits package and no copayments. Particular emphasis on community medicine. States could choose to opt out for residents under age 65 by designing their own system under federal guidelines.

A new Medical Security System would be created to provide universal coverage, making coverage a "right."

Several of the reform plans would have largely or completely replaced the current system built on employer-based coverage and Medicare and Medicaid. Some of these plans can be categorized as single payer systems while others do not quite fit this description, but would make health care a right to all citizens and move away from the job-based system.

All nonelderly legal residents would be guaranteed comprehensive health insurance as a "right" (at no direct cost) through a public insurance approach designed by each state and monitored by the federal government.