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Defining Universal Coverage

Posted by: Ron Pollack, Executive Director of Families USA on Oct 19, 2009

We should make every effort to secure health coverage for all Americans. However, instead of playing a numbers game of what percentage of the American public needs to have health insurance for it to be considered universal health coverage, we should focus on the key measures that need to be taken by Congress to move us towards the universal goal. At least two sets of improvements to the pending bills should receive top-priority attention.

First, we need to ensure that the Medicaid expansions for America's lowest-income people and families -- currently proposed under all pending bills to rise to 133 percent of the federal poverty level (approximately $29,300 in annual income for a family of four) -- truly reach everyone who qualifies for the program. The Urban Institute estimates that, under this improved standard, more than 22.7 million people will become newly eligible for Medicaid coverage. However, the Congressional Budget Office projects that only half of these people will actually be reached and get enrolled. Improving this enrollment will go a long way towards universal coverage.

To achieve optimal enrollment will require rigorous outreach as well as an enrollment system that is user-friendly. New applicants should be enrolled through many portals, including points of health care service; they should be able to sign up without face-to-face interviews (which would cause them to lose a day of work); and they should be able to sign up for coverage when they apply for other means-tested programs. Additionally, since states will continue to administer the program, Congress should eliminate fiscal disincentives to undertake rigorous enrollment by providing full federal funding for the uninsured people newly covered by Medicaid.

Second, Congress needs to improve the affordability of health coverage for people who can receive health coverage through the new exchanges. The sliding-scale tax credit subsidies need to be adequate so that health coverage is truly within the financial reach of currently uninsured people. Improving such affordability will make the individual mandate more realistic and, more importantly, will add many uninsured people to health care coverage. 

 

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This is cross-posted on the National Journal's Expert Blog on Health Care.