Providing Health Coverage for the Uninsured: Time for a Giant Step?

Incremental improvements in coverage have been the focus at both national and state levels for several years. But there are indications that lack of coverage is growing, and broader proposals, aimed at securing coverage for a large number of the uninsured, are beginning to get more attention—tax credits, employer or individual mandates, public program expansions, and various combinations. The plans differ widely in scope, cost and impact, but any of them would mean major change in the status quo.

What are the most talked-about proposals to cover the uninsured? How effective would they be in covering the most people at the lowest cost? How would each affect the private-public balance in providing insurance? What kind of reception will such proposals get on Capitol Hill, in the near future and in the longer term?

To help examine these questions and others, the Alliance for Health Reform and The Commonwealth Fund cosponsored a May 5, 2003 briefing. Speakers represented several different approaches for major coverage expansions. They were: Karen Davis, president of The Commonwealth Fund, and author of a new plan appearing last week in the journal Health Affairs; David Nexon, health policy director for the minority staff of the Senate Labor and Human Resources Committee; Colin Roskey, health policy advisor and counsel, Senate Finance Committee majority; Stephanie Kennan, senior health policy advisor to Senator Ron Wyden, who, with Senator Orrin Hatch, had put forward a plan to bring about a Congressional vote on a comprehensive coverage expansion; Jeff Lemieux, senior economist at the Progressive Policy Institute; and Neil Trautwein, director of employment policy at the National Association of Manufacturers. Ed Howard of the Alliance moderated the discussion.