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The Path to Universal Coverage: Can Health Reform Succeed? HCW Lunch & Learn May 16, 2007 Jonathan Oberlander Department of Social Medicine Department of Health Policy & Administration UNC-Chapel Hill The Odd Couple Familiar Headlines “Number of Uninsured Escalates”
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Department of Social Medicine
Department of Health Policy & Administration
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits: 2005
Source: Uwe Reinhardt
Covering the Uninsured
A long time ago,In a capital not so far awayThe Clinton health plan diedand took with it any political enthusiasm for comprehensive reformUS health policy thus entered the galaxy of incrementalism and inaction, where it remains todayIs there hope for reform?
* New standard tax deduction for health insurance for individual and employer-based insurance:
* Health insurance to be treated as taxable income and above those amounts will be taxed
(27% tax bracket)
(30%-39% tax bracket)
(15% tax bracket)
(0% tax bracket)
(10% tax bracket)
Source: S. A. Glied and D. K. Remler, The Effect of Health Savings Accounts on Health Insurance Coverage (New York: The Commonwealth Fund, April 2005).
Bush plan would increase coverage by 2-5 million uninsured
Value of tax exclusion for employer-sponsored insurance: $188 billion
Estimated increase in federal revenues from Bush proposal to cap that exclusion: $333 billion, 2007-17*
Members of Congress Running for Re-election in 2008: 468
Presidents Running for Re-election in 2008: Zero.
*JCT estimate: Lewin estimates $153 billionrevenue loss 2009-2018.
And when all looked lost, health policy analysts deployed a new weapon in the fight for health reformagainst the Empire of rising costs and uninsured…. A weapon so threatening even insurance companies and providers trembled with fear
“The time has come for universal health care in America.”
--Barack Obama, January 25, 2007
“They're moving toward socialized medicine so fast, it'll make your head spin.”
--Rudy Guliani, April 27, 2007
back tax cuts
“Abandoning the business lobby’s traditional resistance to healthcare reform, a new coalition of 36 major companies plans to launch a political campaign today calling for medical insurance to be expanded to everyone…..”
Los Angeles Times, May 7th, 2007
1. Employer-based system is fraying and perhaps approaching a crossroads: which way do we go? And do employers become the swing voters in health reform?
2. If you’re looking for signs of hope, pay attention to state efforts, SCHIP renewal, 2008 elections.
3. If you’re a pessimist, you’re in luck: things will continue to get worse, especially for low-and middle-income Americans priced out of health insurance
4. Comprehensive reform may be returning to the national political agenda; but there is no guarantee it will pass.
What happens next?...