Policy Research

This policy brief from Health Affairs and the Robert Wood Johnson Foundation, part of a newly launched series of briefings, looks inside the debate over cutting payments to the "Medicare Advantage" programs.

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.

With Congress and the Obama administration discussing how to reform the nation’s health care system, a new analysis looks at what has happened since the last significant reform effort ended in 1994 without any comprehensive congressional action. At the Brink: Trends in America’s Uninsured 1994-2007 chronicles state-by-state health coverage trends. The report finds that over the last 15 years, nearly every state has seen increased numbers of uninsured residents, greater costs for workers while their incomes are flat, and significant erosion of private coverage.

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View a Map of U.S. Uninsured Workers
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Learn about Cover the Uninsured

A modified "play or pay" approach that creates incentives for workers and employers to buy into "Medicare Plus," a national program based on Medicare.

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.

Incentives to encourage people to enroll in a public plan that would ultimately be a single payer. Employers offer coverage or pay 6.5 percent payroll tax. Subsidies to limit premiums to 2.5 percent of income.

"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."

A new analysis from the Urban Institute concludes that these provisions are likely to achieve only partial success.

This paper explores the scope and limits of President Barack Obama's ability to invoke his executive authority to reform health care. Specifically, it identifies ways the Obama administration can use directives to: (1) expand Medicaid and SCHIP coverage through section 1115 waivers; (2) test quality initiatives through Medicare demonstration authority; (3) expand health information technology; (4) allow drug reimportation and experiment with contracting power under Medicare; (5) enhance patient protections and private coverage requirements; (6) lift coverage restrictions on Medicaid and SCHIP; and (7) build on the health insurance program for federal employees.