RESUMEN
This paper presents key insights from California's recent experience in developing a plan for universal health coverage with "shared responsibility" among individuals, employers, and governments. A major challenge was finding an acceptable balance among the goals of affordability, equity, and cost to the state. Although reform did not pass, the state's approach-particularly differences from Massachusetts regarding modest-income workers and related employer and public roles-provides important insights for federal reform.
Asunto(s)
Seguro de Costos Compartidos/legislación & jurisprudencia , Reforma de la Atención de Salud/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Atención no Remunerada/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , California , Financiación Gubernamental/economía , Financiación Gubernamental/legislación & jurisprudencia , Financiación Personal/legislación & jurisprudencia , Planes de Asistencia Médica para Empleados/economía , Planes de Asistencia Médica para Empleados/legislación & jurisprudencia , Reforma de la Atención de Salud/economía , Política de Salud/economía , Humanos , Renta , Massachusetts , Atención no Remunerada/economía , Cobertura Universal del Seguro de Salud/economíaRESUMEN
Moving toward universal participation in health insurance using a "shared responsibility" approach requires new, more accessible, and more efficient ways for people who are not offered employer coverage to obtain coverage. California's recent health reform plan-which failed to pass-incorporated individual market reform and choice-pool constructs to achieve critically important risk spreading, assure solvency, and reduce cost shifts. These measures, as well as the considerations that led to their design, offer important insights for health reform at the federal level.
Asunto(s)
Seguro de Costos Compartidos/legislación & jurisprudencia , Reforma de la Atención de Salud/legislación & jurisprudencia , Política de Salud/legislación & jurisprudencia , Atención no Remunerada/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , California , Análisis Costo-Beneficio/economía , Análisis Costo-Beneficio/legislación & jurisprudencia , Financiación Gubernamental/economía , Financiación Gubernamental/legislación & jurisprudencia , Financiación Personal/legislación & jurisprudencia , Planes de Asistencia Médica para Empleados/economía , Planes de Asistencia Médica para Empleados/legislación & jurisprudencia , Reforma de la Atención de Salud/economía , Política de Salud/economía , Humanos , Renta , Fondos de Seguro/economía , Fondos de Seguro/legislación & jurisprudencia , National Health Insurance, United States/economía , National Health Insurance, United States/legislación & jurisprudencia , Política , Prorrateo de Riesgo Financiero/economía , Prorrateo de Riesgo Financiero/legislación & jurisprudencia , Atención no Remunerada/economía , Estados Unidos , Cobertura Universal del Seguro de Salud/economíaRESUMEN
The basic provisions of the proposal by George Halvorson and colleagues provide a realistic way for many states to afford coverage for their uninsured residents. In this commentary we suggest some modifications to achieve a more viable plan.
Asunto(s)
Reforma de la Atención de Salud , Pacientes no Asegurados , Planes Estatales de Salud , Cobertura Universal del Seguro de Salud , California , Planes Médicos Competitivos , Humanos , Garantía de la Calidad de Atención de Salud , Estados UnidosRESUMEN
If tax credits or other public subsidies are made available only for health insurance that is not employment-based, serious erosion of employer coverage could result. To prevent this, public subsidies targeted to low-income workers and families could be applied in ways that broaden employer coverage for low-income workers and their families by encouraging small employers with largely low-wage workforces to offer and partially fund health coverage for their workers. To accomplish this, such employers--very few of which now provide health coverage--must be allowed to contribute much less than normally required in the commercial market.