Health Insurance Comparison: ACA vs Single Coverage

1. ACA vs Single Health Insurance A Complete Comparison Single-Payer System Affordable Care Act Incremental Reform Universal Coverage November 20, 2025 Healthcare Policy Analysis

2. Introduction to Healthcare Models The United States employs two distinct approaches to healthcare provision, each with unique principles and implementations. Affordable Care Act (ACA) Single-Payer System Market-based reform building upon existing insurance system Universal coverage model financed by government Single public authority pays for all healthcare services Expands coverage through subsidies and Medicaid expansion Eliminates private health insurance for essential benefits Typically covers all medically necessary services Maintains multi-payer structure with private insurance Individual and employer mandates to increase coverage Core Distinction The fundamental difference lies in approach: ACA reforms the existing system while a single-payer model replaces the multi-payer structure with universal coverage. 2/10

3. The Affordable Care Act (ACA) - Core Principles Enacted in March 2010, the ACA was designed with three primary goals to reform the U.S. healthcare system: Making Insurance Affordable Expanding Medicaid Supporting Innovation The law aimed to expand Medicaid eligibility to cover all adults with incomes below 138% of the federal poverty level. However, not all states have adopted this expansion. The ACA seeks to foster new approaches to healthcare delivery that are designed to reduce overall healthcare costs while improving quality and coordination of care. The ACA provides subsidies, specifically premium tax credits, to individuals and households with incomes between 100% and 400% of the federal poverty level to help lower the cost of health insurance premiums. Key feature: Medicaid expansion varies by state, creating uneven coverage access across the U.S. Key feature: Incentives for Accountable Care Organizations and value-based care models. Key feature: Income-based premium tax credits make coverage more affordable for middle-class families. 3/10 These three principles work together to increase access to affordable healthcare coverage and improve the efficiency of the healthcare system.

4. How the ACA Works - Marketplace and Financial Assistance Health Insurance Marketplace Metal Tiers An organized platform for individuals and families to shop for health insurance plans. Plans are categorized into "metal tiers" based on the percentage of healthcare costs they cover: Offers certified health plans from private insurers Plan Tier Monthly Premiums Out-of-Pocket Costs Covered Costs Provides tools for comparison shopping Assists consumers in understanding options Can be operated by states or the federal government Bronze Lowest Highest 60% Silver Moderate Moderate 70% Gold Higher Lower 80% Financial Assistance Platinum Highest Lowest 90% Premium Tax Credits Subsidies to lower monthly premium costs for households with incomes between 100% and 400% of the FPL. Catastrophic plans are available for individuals under 30 or those with hardship exemptions. Cost-Sharing Reductions Reduces out-of-pocket expenses for households with incomes between 100% and 250% of the FPL who enroll in Silver plans. 4/10

5. ACA Impact and Performance Coverage Expansion Achievements Uninsured Rate Reduction The ACA has significantly expanded health insurance coverage since its implementation in 2010. Uninsured Rate Total Enrollment Decreased from 45+ million 7.7% 16% ACA-related insurance plans (early 2024) Rate in late 2023 In 2010 Marketplace Medicaid Expansion Coverage Gains by Demographics 20.5 million 18.6 million Largest gains among poor and near-poor individuals, particularly adults Consumers enrolled (February 2024) Newly eligible adults enrolled (Sept 2023) People of color experienced larger reductions in uninsured rates compared to White individuals (2013-2016) Medicaid expansion showed the greatest coverage gains among newly eligible adults 5/10

6. Single-Payer System - Core Principles A single-payer healthcare system features a universal model where a single public authority finances healthcare services for all residents. Universal Coverage Single Financing Source Comprehensive Benefits Guarantees health coverage for all residents, irrespective of income, employment status, or health conditions. Government collects all healthcare funds through taxes and acts as the sole payer for services. Provides a broad range of medically necessary services, including preventive care, hospitalizations, and prescription drugs. Elimination of Cost-Sharing Price Regulation Administrative Efficiency Leveraging market power to negotiate and set prices for healthcare services, equipment, and prescription drugs. Reduces administrative overhead by simplifying billing and claims processes associated with multiple insurers. Removes deductibles, copayments, and coinsurance for covered services, reducing financial barriers to care. 6/10

7. How Single-Payer Works - Funding and International Examples Tax-Based Financing International Examples Healthcare funded through general tax revenues Canada United Kingdom Eliminates private insurance premiums • Structure: Public financing, private delivery • Structure: Government-owned, public service Administrative Efficiency • Funding: Provincial taxes (70% government-funded) • Funding: General tax revenue • Healthcare: 9.7% of GDP Current System Single-Payer • Healthcare: 10.0% of GDP 15-20% 2-5% • Life Expectancy: 81.7 years • Life Expectancy: 82.3 years Administrative Costs Administrative Costs Healthcare Spending (% GDP) 7/10

8. Coverage and Access Comparison ACA Coverage Single-Payer Coverage Targeted Expansion Universal Coverage Aims to expand coverage to more people through subsidies and Medicaid expansion. Guarantees health coverage for all residents, eliminating coverage gaps. Pre-existing Conditions Pre-existing Conditions Protections against denial of coverage based on health status. Comprehensive protections ensuring access regardless of health status. Coverage Gaps Comprehensive Benefits Approximately 7.7% remain uninsured .5 mr-2" style="color: #FF7F50;"> Coverage for dental, vision, and long-term care Medicaid expansion gap in non-participating states Elimination of cost-sharing for essential services Key Difference While ACA seeks to expand coverage through subsidies and Medicaid expansion, a single-payer system would provide universal coverage, ensuring access to healthcare for all residents. 8/10

9. Cost Analysis and Administrative Efficiency Administrative Efficiency Individual Cost Differences ACA Individual Costs Single-Payer Individual Costs Monthly premiums subsidies for eligible individuals No premiums (tax-based financing) Eliminated deductibles for covered services Deductibles (Bronze plans ~$5,300 average) Minimal or no copayments for most services Administrative costs as percentage of total healthcare costs Copayments & coinsurance for services Key Efficiency Factors Cost-Shifting Implications ACA: Multiple insurance plans lead to complex billing and management Single-payer systems shift from direct patient payments to tax financing, simplifying costs at the point of care while potentially increasing overall tax contributions based on income. Single-payer: Simplified billing and elimination of private insurance overhead 9/10

10. Key Takeaways and Future Considerations Fundamental Distinction The ACA represents an incremental reform building upon the existing mixed public-private insurance market, while a single-payer system advocates for a complete overhaul, replacing the multi-payer structure with universal coverage. ACA Reform Approach Single-Payer Transformation Expanded coverage through subsidies and Medicaid expansion Universal coverage for all residents regardless of status Single government payer replaces private insurance Maintained private insurance as primary provider Streamlined administration (2-5% overhead) Multi-payer administrative complexity (15-20% overhead) Requires significant upfront funding mechanism Remained vulnerable to market fluctuations Future Considerations The choice between these approaches reflects broader questions about the role of government, market forces, and individual responsibility in healthcare provision. Success depends on political feasibility, economic factors, and evolving healthcare needs of the population. 10/10