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. In doing so, it also reviews many of the major issues that arise in designing such proposals. This document does not provide a comprehensive analysis of any specific proposal; rather, it identifies and discusses many of the critical factors that would affect estimates of various proposals. In accordance with CBO's mandate to provide objective and impartial analysis, the report makes no recommendations.

1. Introduction and background -- 2. Approaches for reducing the number of uninsured people -- 3. Factors affecting insurance premiums -- 4. Proposals affecting the choice of an insurance plan -- 5. Factors affecting the supply and prices of health care services -- 6. Administrative issue and effects on other programs -- 7. Changes in health habits and medical practices -- 8. effects on total health care spending, the scope of the federal budget, and the economy, Tables, Figures, Boxes.

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. Medicare already provides nearly universal coverage to the elderly, those proposals generally focus on options for providing coverage to and reducing costs for the non-elderly population. 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 and others. This book 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.

Americans are accustomed to anecdotal evidence of the health care crisis. Yet, personal or local stories do not provide a comprehensive nationwide picture of our access to health care. Now, this book offers the long-awaited health equivalent of national economic indicators. This useful volume defines a set of national objectives and identifies indicatorsâ€"measures of utilization and outcomeâ€"that can "sense" when and where problems occur in accessing specific health care services. Using the indicators, the committee presents significant conclusions about the situation today, examining the relationships between access to care and factors such as income, race, ethnic origin, and location. The committee offers recommendations to federal, state, and local agencies for improving data collection and monitoring. This highly readable and well-organized volume will be essential for policymakers, public health officials, insurance companies, hospitals, physicians and nurses, and interested individuals.

Over the past several years, federal and state policymakers have considered a variety of proposals to increase health insurance coverage among the nation's residents. The federal government has devoted considerable effort, encompassing public health programs and tax incentives, to encourage U.S. residents to obtain health insurance. This book describes a model the Congressional Budget Office (CBO) developed to simulate and analyse an array of policy options involving health insurance coverage. It describes the model's design, basic methodology, and fundamental assumptions. To illustrate the model's use, this book reports estimates for two scenarios in which policy regarding health insurance coverage would differ from current law. This is an edited, excerpted and augmented edition of a Congressional Budget Office report.