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Jon Gardner at Health Affairs
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Authors Propose Universal Coverage Plan Using Federal Health Plan
And Medicaid, Financed By New Value-Added Tax

Health Affairs Article Says Expanding Coverage Is A Moral Imperative
That Can Overcome Political Resistance


BETHESDA, MD — The United States could achieve universal health care coverage by allowing access to a pool like the federal workers’ health plan, expanding Medicaid, and financing any increase in cost by implementing a value-added tax on some goods and services, according to a new article posted today on the Health Affairs Web site.

The universal coverage plan does not propose changes to employer-sponsored insurance, but it would give employers and employees the added option of enrolling in a pool modeled on the Federal Employees Health Benefits Program (FEHBP). This would help workers whose employers do not offer health care coverage, as well as those whose employers offer only a single insurance product, according to the authors, Jeanne M. Lambrew, John D. Podesta, and Teresa L. Shaw of the Center for American Progress.

The plan also proposes expanding Medicaid to cover all people up to 100–150 percent of the federal poverty level and increase the federal government’s contribution to state Medicaid programs.

To ensure universal coverage, every American would be expected to enroll in a health insurance plan through their employer, the new insurance pool, or Medicaid. Those who do not would pay an income-related assessment to contribute to the costs of the care they will inevitably need.

Among the plan’s additional components to improve coverage while expanding it:

— Carving out preventive services from current health insurance coverage and creating a national preventive benefit. Reimbursement to clinicians would be based on their ability to improve community-based health promotion and disease prevention measures.

— Research into clinical effectiveness of various treatments and broad dissemination of findings to help patients make better decisions about their treatment options.

— Adoption of information technologies such as electronic medical records and computerized physician order entry, through Medicare reimbursement and a new health IT infrastructure improvement fund.


Additional funding would be necessary to pay for the plan, which has an estimated cost of $100–$160 billion a year. The authors propose a value-added tax in the range of 3–4 percent.

“We do not underestimate the political challenge involved in making the U.S. health system accessible to all,” the authors write. “However, we reject the claims that health reform is doomed by political paralysis and an incapacity for Americans to sacrifice for the greater good. At opportune points in U.S. history, pragmatic ideas have overcome seemingly impossible political odds and become policy.”

“For most Americans, ensuring access to affordable, high-quality health care is not a question of the political left or right, but a matter of right and wrong,” the authors write. “The challenge is translating these convictions into pressure for improvement. We aim to lead an effort to squarely juxtapose the urgency and moral imperative of health reform with competing congressional and White House priorities.”

Lambrew is a senior fellow at the Center for American Progress and a professor at the George Washington University School of Public Health and Health Services. Podesta is president and chief executive officer of the center. Shaw is the center’s associate director of domestic policy.

You can read the article at content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.119.

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print, with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.

 

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©2005 Project HOPE–The People-to-People Health Foundation, Inc.