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to: IHPS California



CHCF MA Style Brief

Three Options for Insuring All Californians

Authors: Rick Curtis, Ed Neuschler

October, 2006

With support from the California HealthCare Foundation, IHPS has developed and analyzed three alternative state coverage strategies to to bring virtually all Californians into health coverage. The models would all require individuals to participate, but would respectively assign varying levels of responsibilities to employers and the state. All three models would harness federal tax subsidies available for contributions made at work and include sliding-scale subsidiesfor low-income persons, as well as a coverage venue (a health insurance exchange) for individuals to assure that health insurance is accessible and affordable for all. The three models examined are:

    1. Basic Individual Mandate, requiring individuals to obtain coverage, employers to collect and arrange tax benefits for worker contributions, and government to provide premium assistance for low-income Californians;
    2. Pay-or-Play Plus, combining an individual mandate and premium assistance with a minimum employer payment floor, including payroll fees for their part-time workers; and
    3. All-Consumer Choice Exchange (ACE), replacing today's employer-by-employer coverage system with a health insurance "exchange" or "choice pool" funded primarily by percent of payroll premiums from all employers and workers.

Both an executive summary and a detailed analysis are available. The executive summary provides an overview of the three approaches. It identifies their essential components and surmises how they would affect employers, individuals, and the state budget.

The complete report provides detailed descriptions of the coverage models, including common elements, differentiating features, key assumptions, and estimated costs. It also highlights health care cost trends and comparisons of the models by source of coverage and estimated cost by payer.

The reports are intended to inform policymakers in their efforts to devise a more comprehensive health coverage system, and to identify affordable and workable designs.

Both the executive summary and the complete report are available via the links in the box on the right. Also available is an appendix describing the database used to make the cost estimates.

A related earlier report, "Massachusetts-Style Coverage Expansion: What Would It Cost in California" remains available.

This report was prepared for the California HealthCare Foundation.


PDF File of Executive Summary 93K KB)
PDF File of Full Report 581K KB)
PDF File of Appendix 74K KB)
See Also: Purchasing Pools, Tax Subsidies, Coverage By and For All