This report analyzes how eight health care reform packages intended to address the current system’s shortcomings affect health insurance coverage and spending by government, households, and employers. We start with a set of incremental improvements to the ACA, similar to some of those in the Consumer Health Insurance Protection Act of 2019, and end with a single-payer-type comprehensive reform similar to the Medicare for All Act of 2019

How are Americans feeling about the health care system, and what do progressive proponents of expanded Medicare need to consider? Two years after Republicans tried and failed to repeal the Affordable Care Act, health care is still a key issue for Americans. Democrats are more trusted than Republicans to solve our health care woes, and the public strongly supports protecting and expanding Medicare. But progressives must deal with questions about what proposals like Medicare for All really mean and explain how they will keep health care costs down.

As economists, we understand that a single-payer “Medicare for All” health insurance system for the U.S. can finance good-quality care for all U.S. residents as a basic right while still significantly reducing overall health care spending relative to the current exorbitant and wasteful system. Health care is not a service that follows standard market rules. It should therefore be provided as a public good.

As policymakers debate next steps for expanding health insurance coverage and lowering health costs, some have introduced legislation that would broaden the role of public programs, such as Medicare and Medicaid. During the 115th Congress, eight such proposals were introduced, ranging from bills that would create a new national health insurance program for all U.S. residents, replacing virtually all other sources of public and private insurance (Medicare-for-All), to more incremental approaches that would create a new public plan option, as a supplement to private sources of coverage and public programs.

Large price discrepancies exist between what private health plans pay for hospital services and what Medicare pays. RAND Corporation researchers used data from three sources — self-insured employers, state-based all-payer claims databases, and health plans — to assess $13 billion in hospital spending in terms of hospital price levels, variation, and trends from 2015 through 2017 in 25 states.

This report describes the primary features of single-payer systems, and it discusses some of the design considerations and choices that policymakers will face as they develop proposals for establishing such a system in the United States. The report does not address all of the issues involved in designing, implementing, and transitioning to a single-payer system, nor does it analyze the budgetary effects of any specific proposal.

One of the often-discussed proposals to reform the health care system is a single-payer plan, sometimes called “Medicare for All.” Arguments for and against are wide ranging. There is also considerable confusion as to what “single payer” means and how it might operate. Consequently, this brief presents both a general picture of the most frequently mentioned single-payer proposal, and we delineate the advantages and disadvantages of the approach without taking a position on its advisability. Such clarification is necessary to advance a constructive debate over next steps for improving the US health insurance system. The authors first make five contextual points that are critical to better understanding the debate around single-payer plans, as well as a list of pros and cons.

Goals of these proposals vary and include increasing access to affordable coverage, exerting downward pressure on provider prices, increasing plan availability, and reducing the number of uninsured. This issue paper from the American Academy of Actuaries Health Practice Council briefly outlines four approaches aiming to achieve such goals and highlights the key design elements that would need to be specified for an approach to be fully evaluated and implemented.

1332 waivers are one way CMS is providing states with flexibility to establish innovative ways to stabilize the risk pool and meet the needs of their residents in their particular states. These Section 1332 waivers are now called State Relief and Empowerment Waivers to reflect this new direction and opportunity.

The Mercatus Center released a report that estimated that the Sanders single payer plan would cost 32 trillion over ten years. This was close to an earlier estimate done by the Urban Institute. There are important differences between the two studies but the bottom lines are similar. The Mercatus Center released a report that estimated that the Sanders single payer plan would cost 32 trillion over ten years. This was close to an earlier estimate done by the Urban Institute. There are important differences between the two studies but the bottom lines are similar. The Sanders plan would mean a very large increase in federal health care spending. In this brief, we compare the two approaches and show that there are an array of alternative proposals that could achieve most of the same objectives at a lower federal budget cost.

Medicare-for-All, an approach championed most recently by Senator Sanders in the Senate and Representative Ellison in the House, represents the most sweeping proposed change to the U.S. health insurance system among these proposals. Once fully implemented, a single, federal, government-administered program would provide coverage to all U.S. residents.

Prices for hospital admissions have received considerable attention in recent years, both because they are an important component of health care spending and because they can vary widely. In this paper, we use 2013 claims data from three large insurers to examine the hospital payment rates of those insurers in their commercial plans and their Medicare Advantage plans and compare them with Medicare’s fee-for-service (FFS) rates; we also examine the variation of those rates across and within markets

Presidential candidate Senator Bernie Sanders has called for adopting a single-payer health care system in the United States.1 He proposes replacing the programs established under the Affordable Care Act (ACA), as well as preexisting public programs such as Medicaid and Medicare, with the new system. Under his approach, all individuals in the United States would be covered by a single insurance program. Sanders’s plan would eliminate all private spending and replace all private and public coverage programs, except Veterans Health Insurance and the Indian Health Service. Benefits provided under the insurance plan would cover all medically necessary services, and cost sharing would be eliminated entirely. Coverage would include both acute and long-term care.

Under this option, the Secretary of Health and Human Services would establish and administer a public health insurance plan that would be offered through the exchanges, alongside private plans, starting in 2016. The public plan would have to charge premiums that fully covered its costs, including administrative expenses. The plan’s payment rates for physicians and other individual practitioners would be set 5 percent higher than Medicare’s rates in 2013 and would rise in later years to reflect estimated increases in physicians’ costs; those payment rates would not be subject to the future reductions required by Medicare’s sustainable growth rate formula.