Key Issues in Analyzing Major Health Insurance Proposals

摘要

Concerns about the number of people who lack health insurance and about the high and rising costs of health insurance and health care have led to proposals that would substantially modify the health insurance system in this country. Because the Medicare program already provides nearly universal coverage to the elderly, those proposals generally focus on options for providing coverage to and reducing costs for the nonelderly population. Because most nonelderly people obtain their insurance coverage through an employer, proposals could affect that coverage in some way. They could, for example, provide new federal subsidies to pay some portion of health insurance premiums; impose mandates for individuals to purchase coverage or for employers to offer it; encourage alternatives to employment-based insurance or provide strong incentives to purchase coverage individually; or create new federally administered options for obtaining health insurance (including a single-payer system in which all citizens or residents would be offered coverage under Medicare). This report describes some of the key assumptions that the Congressional Budget Office (CBO) would use in estimating the effects of key elements of such proposals on federal costs, insurance coverage, and other outcomes; the evidence on which those assumptions are based; and if the evidence points to a range of possible effects rather than a precise prediction the factors that would influence where a proposal falls within those ranges.