Medicaid and the U.S. Path to National Health Insurance

Michael Sparer argues that the most plausible path toward universal coverage is, first, to expand Medicaid to cover the largest portion of the uninsured and, second, to require everyone to carry health insurance — while allowing people whose incomes are too high for automatic coverage to buy into Medicaid. The 2008 presidential election has rekindled long-simmering hopes for comprehensive health care reform. The policy debate includes references to new government programs (perhaps a federal program for the uninsured to buy into) and vague formulas for cost containment (usually involving overly optimistic assessments of savings to be generated by using health information technology). Ironically, however, the debate generally ignores what I see as the most plausible path toward universal coverage: first, expanding Medicaid to cover the largest portion of the uninsured, Americans with incomes below 350% of the federal poverty level (around $62,000 for a family of three); and second, . . .