Private Proposals Aim To Reduce Lack of Coverage

Two new proposals to solve the conundrum of Americans without health coverage would build on the country's existing health system.

The Health Insurance Association of America and Families USA, admitting to a case of "strange bedfellows," put forth a plan they say would cover more than half of the nation's 43 million uninsured.

Under the plan, states would be required to expand Medicaid to all Americans under 65 whose incomes are below 133 percent of poverty, and to establish a Medicaid-like program for those with incomes between 133 percent and 200 percent of poverty. Employers would be given tax credits for helping low-income employees pay their share of premiums for employer-sponsored coverage.

The proposal, which would cost about $250 million over 10 years, was laid out in detail in the January/February issue of Health Affairs.

Separately, the Commonwealth Fund suggested a plan providing "default coverage" — a safety net — until a person joins a specific plan or refuses any coverage.

Its proposal, published in the Archives of Internal Medicine, calls for all workers to be enrolled in their employers' coverage, with tax credits for businesses to encourage them to offer coverage; people whose employers offer no coverage would be given tax credits to join the Federal Employees Health Benefits Program. In addition, Medicare would be extended to anyone unable to get private coverage for health reasons.

Archives editor James Dalen, M.D., called the plan, which is projected to reduce the number of uninsured to 6 million by 2020, "the first feasible plan for achieving near-universal coverage I have seen."

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