Blumberg Linda J, Holahan John, Weil Alan, Clemans-Cope Lisa, Buettgens Matthew, Blavin Fredric, Zuckerman Stephen
Urban Institute, Washington, DC 20037, USA.
Inquiry. 2006 Summer;43(2):102-21. doi: 10.5034/inquiryjrnl_43.2.102.
This paper presents several options designed to help the Commonwealth of Massachusetts move to universal health insurance coverage. The alternatives all build upon a common base that includes an expansion of the Medicaid program, income-related tax credits, a purchasing pool, and government-sponsored reinsurance. These measures in themselves would not yield universal coverage, nor would an employer mandate by itself. We show that an individual mandate, and an employer mandate combined with an individual mandate, both would yield universal coverage with a relatively small increase in government costs relative to state gross domestic product and current health spending. The cost of an employer mandate--with a "pay or play" design--is sensitive to the payroll tax rate and base, the number and kind of exemptions, and whether workers whose employers "pay" receive discounts when they purchase health insurance. The development of these alternatives and their analyses contributed to the eventual health care compromise that emerged in Massachusetts in April 2006.
本文提出了几种旨在帮助马萨诸塞州实现全民医疗保险覆盖的方案。这些方案均基于一个共同基础构建而成，该基础包括扩大医疗补助计划、与收入相关的税收抵免、一个采购池以及政府资助的再保险。这些措施本身无法实现全民覆盖，单独的雇主强制参保规定也不行。我们表明，个人强制参保规定，以及雇主强制参保规定与个人强制参保规定相结合，相对于州国内生产总值和当前医疗支出而言，都能以政府成本相对较小的增加实现全民覆盖。具有“支付或参与”设计的雇主强制参保规定的成本对工资税率和基数、豁免的数量和种类，以及雇主“支付”费用的工人在购买医疗保险时是否能获得折扣很敏感。这些方案的制定及其分析促成了2006年4月在马萨诸塞州最终达成的医疗保健妥协方案。
