An Analysis of Leading Congressional Health Care Bills, 2007–2008: Part I, Insurance Coverage

An Analysis of Leading Congressional Health Care Bills, 2007–2008: Part I, Insurance Coverage
January 9, 2009 | Volume 102
Authors:
Sara R. Collins, Ph.D, Jennifer L. Nicholson, and Sheila D. Rustgi
Contact:
src@cmwf.org

Overview
This report analyzes and compares leading bills of the 110th Congress aimed at expanding and improving health insurance coverage. Bills and proposals from members of Congress and President-elect Barack Obama include plans to fundamentally reform the health insurance system through mixed private–public approaches that build on our current system; a public insurance option available to the entire population; bills to change the tax treatment of employer benefits; federal–state partnership to provide grants to states to expand coverage; and bills that would expand coverage for children or disabled individuals, among others. Using analysis from the Lewin Group, the authors provide coverage and cost estimates for the proposed bills, which range from 48.9 million uninsured people gaining coverage to a net loss of coverage for 283,000 people; proposals could increase national health spending by as much as $64.1 billion or create savings of $58.1 billion.

Executive Summary
This report—the first of a two-part series—analyzes and compares leading bills of the 110th Congress that are aimed at expanding and improving health insurance coverage. The Commonwealth Fund commissioned the Lewin Group <1> to estimate the effect of the bills on stakeholder and health system costs and the projected number of people the bills would insure. The Fund also commissioned Health Policy R&D, a health policy firm, to create detailed side-by-side comparative analyses of the bills as well as summaries. The report also includes an analysis of the proposals outlined by President-elect Barack Obama and Senator Max Baucus (D-Mont.), focusing on the insurance coverage provisions of those proposals. Because President-elect Obama and Senator Baucus have proposed frameworks for expanding coverage that lack key details, Lewin provided an estimate of the Building Blocks proposal—published in a Health Affairs article by Cathy Schoen and colleagues at The Commonwealth Fund—which is similar to the Obama and Baucus plans.

Under the current laws, Lewin projects that the number of uninsured in the United States will rise to 48.9 million people in 2010 out of a total estimated population of 306.9 million; 15.9 percent of the total population will be uninsured. Among the plans analyzed, Lewin estimates that up to 48.9 million uninsured could be covered—under a bill proposed by Representative Pete Stark (D–Calif.). At the other end of the spectrum, a bill introduced by Representative Sam Johnson (R–Texas), would result in a net loss of coverage of 283,000. According to Lewin's cost estimates, total health spending could be as high as $64.1 billion—under a bill proposed by Senator Mike Enzi (R–Wyo.)—or we could see net savings of $58.1 billion under Rep. Stark's bill. All coverage and cost estimates are for 2010 and are based on the assumption of full implementation in 2010.

The bills and proposals to expand health insurance coverage take a variety of approaches to achieve incremental as well as more comprehensive expansions in coverage. They fall into four broad categories:

fundamental reforms of the nation's health insurance system;
expansions of existing public insurance programs;
new options for small employers;
expansions of health savings accounts.

Detailed report and analysis at link.