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Health Reform Ideas in the Primeval Soup
Unformatted Document Text:  25 insurance with a subsidy for those with low income. The idea has become more prominent since it became a core feature of the recent Massachusetts health reform idea. 62 Basic Concepts 63 The individual mandate policy idea begins with a requirement that all individuals have health insurance coverage. For most this has already been achieved by workplace or individual insurance, or current participation in Medicare or Medicaid. Because low income individuals may not be able to afford the premium of a market rate insurance policy, the individual mandate requires some type of subsidy to reduce the price of the premium. Insurance market reforms and purchasing pools are typical additional features of individual mandate based proposals. Enforcement of the mandate requires some type of penalty and enforcement mechanism, perhaps through the tax system. There is also the need for a regulation process to assure the benefit structure of the policy meets a minimum standard. Also, this requirement assumes the individual will be able to purchase a standard policy at a reasonable price, even if they have a history of health problems. Thus, the inclusion in the articulation of the policy idea some mechanism for improving the market for individual health insurance policies, such as purchasing pools. Part of the case for an individual mandate often also includes eliminating the current health insurance tax deduction and replacing it with an income related refundable tax credit. 64 Strengths This approach achieves universal coverage because everyone is obligated to have insurance coverage. The size of the subsidy costs for the federal government are determined by the depth of the subsidy. This approach retains and expands the private insurance market, and strengthens it, when combined with market reforms. Economists, such as Pauly, who are advocates of individual an mandate argue the necessary subsidies are more targeted because they go to the person, not the employer. 65 Weaknesses While retaining the private insurance model, the individual mandate idea does require a number of additional types of expenditures by the federal government. In addition to the 62 Kaiser Commission on Medicaid and the Uninsured, “Massachusetts Health Care Reform Plan: An Update”, Fact Sheet, June 2007. 63 Linda Blumberg and John Holanhan, “Do Individual Manadates Matter?” Urban Institute Fact Sheet, January 2008.; Jeanne Lambrew and Jonathan Gruber, “Monday and Mandates: Relative Effects of Key Policy Levers in Expanding Health Insurance Coverage to All Americans”, Inquiry, (Winter 2006-07) pp.333-44; Pauly, “Case for Employer-Enforced Individual Mandates, op. cit. 64 Pauly, “Plan for Responsible NHI”, op. cit 65 Pauley, “Case for Employer Enforced Individual Mandates”, op. cit, p.31-32

Authors: Brasfield, James.
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25
insurance with a subsidy for those with low income. The idea has become more
prominent since it became a core feature of the recent Massachusetts health reform idea.
62
Basic Concepts
63
The individual mandate policy idea begins with a requirement that all individuals have
health insurance coverage. For most this has already been achieved by workplace or
individual insurance, or current participation in Medicare or Medicaid. Because low
income individuals may not be able to afford the premium of a market rate insurance
policy, the individual mandate requires some type of subsidy to reduce the price of the
premium.
Insurance market reforms and purchasing pools are typical additional features of
individual mandate based proposals. Enforcement of the mandate requires some type of
penalty and enforcement mechanism, perhaps through the tax system. There is also the
need for a regulation process to assure the benefit structure of the policy meets a
minimum standard.
Also, this requirement assumes the individual will be able to purchase a standard policy
at a reasonable price, even if they have a history of health problems. Thus, the inclusion
in the articulation of the policy idea some mechanism for improving the market for
individual health insurance policies, such as purchasing pools.
Part of the case for an individual mandate often also includes eliminating the current
health insurance tax deduction and replacing it with an income related refundable tax
credit.
64
Strengths
This approach achieves universal coverage because everyone is obligated to have
insurance coverage. The size of the subsidy costs for the federal government are
determined by the depth of the subsidy. This approach retains and expands the private
insurance market, and strengthens it, when combined with market reforms. Economists,
such as Pauly, who are advocates of individual an mandate argue the necessary subsidies
are more targeted because they go to the person, not the employer.
65
Weaknesses
While retaining the private insurance model, the individual mandate idea does require a
number of additional types of expenditures by the federal government. In addition to the
62
Kaiser Commission on Medicaid and the Uninsured, “Massachusetts Health Care Reform Plan: An
Update”, Fact Sheet, June 2007.
63
Linda Blumberg and John Holanhan, “Do Individual Manadates Matter?” Urban Institute Fact Sheet,
January 2008.; Jeanne Lambrew and Jonathan Gruber, “Monday and Mandates: Relative Effects of Key
Policy Levers in Expanding Health Insurance Coverage to All Americans”, Inquiry, (Winter 2006-07)
pp.333-44; Pauly, “Case for Employer-Enforced Individual Mandates, op. cit.
64
Pauly, “Plan for Responsible NHI”, op. cit
65
Pauley, “Case for Employer Enforced Individual Mandates”, op. cit, p.31-32


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