Key Issues in Analyzing Major Health Insurance Proposals

CONGRESS OF THE UNITED STATES CONGRESSIONAL BUDGET OFFICE CBO Key Issues in Analyzing Major Health Insurance Proposals DECEMBER 2008 Pub. No. 3102 A CBO S T U D Y Key Issues in Analyzing Major Health Insurance Proposals December 2008 The Congress of the United States O Congressional Budget Office Notes Numbers in the text and tables may not add up to totals because of rounding. This document references a number of the Congressional Budget Office’s (CBO’s) cost estimates and other publications, which are available at CBO’s Web site, www.cbo.gov. Preface oncerns 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 substan-tially 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 adminis-tered options for obtaining health insurance (including a single-payer system in which all citi-zens 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 dis-cusses many of the critical factors that would affect estimates of various proposals. In accor-dance with CBO’s mandate to provide objective and impartial analysis, the report makes no recommendations. This report is the product of an intense effort on the part of a large number of CBO analysts. Philip Ellis and Janet Holtzblatt of CBO’s Health and Human Resources Division organized and revised the final drafts of each chapter, under the supervision of James Baumgardner. David Auerbach, Lyle Nelson, Ben Page, Lara Robillard, Rob Stewart, and Chapin White contributed major sections of the report and drafted several of its chapters. Other significant contributions came from Colin Baker, Paul Cullinan, Noelia Duchovny, Renee Fox, Tim Gronniger (formerly of CBO), Stuart Hagen, Keisuke Nakagawa, Jean Hearne, Melissa Merrell, Allison Percy, Lisa Ramirez-Branum, Bill Randolph, and David Weiner. In addition, Tom Bradley, Pete Fontaine, Keith Fontenot, Holly Harvey, Kate Massey, and Bruce Vavrichek provided important guidance on the report throughout its development. The analysis also benefited greatly from comments by Joseph Newhouse of Harvard University and ... - tailieumienphi.vn