View Research by Author - Matthew Buettgens

Citation URL: http://www.urban.org/MatthewBuettgens

Congressional proposals health care reform proposals have differed in the premium rating rules that would be applied to non-elderly adults. Some have proposed allowing premiums for the older adults to be as much as 5 times as high as those for younger adults (5:1 rating), while others would limit the highest premiums to be twice that of the lowest (2:1 rating). This analysis uses the Health Insurance Policy Simulation Model (HIPSM) to compare the financial implications of the premium rating choice (5:1, 2:1, and 1:1) for households of different ages, incomes, and sizes.

Under contract to the State of New York, researchers conducted in-depth micro-simulation analyses of four types of health care reforms being considered for state implementation: a single payer public health insurance option, Assembly Member Gottfried's New York Health Plus proposal that provides an option for all New Yorkers to enroll in Family Health plus, public-private hybrid options that simplify and expand existing public programs and reform private health insurance, and a market-based option that relies on regulatory flexibility and tax credits. The cost and coverage implications of state reform options falling into these four categories are presented in this report.

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.

This report synthesizes all of the research and analytic work done on the Roadmap initiative, describes three policy approaches that would achieve universal health coverage in the Commonwealth, and describes the issues that would need to be addressed in order to implement the Roadmap options. The report describes each of the building blocks in turn, followed by the mandate alternatives. The cost and coverage estimates were produced using the Health Insurance Reform Simulation Model, developed by Urban Institute researchers. The report also discusses options for financing the coverage expansions, the likely benefits from universal coverage, and the broader economic impacts.

This report presents several options designed to help Massachusetts move to universal health insurance coverage. Each strategy is outlined in the form of a policy proposal and includes analysis of the effects on cost and coverage. The policies all build on an expansion of MassHealth, income-related tax credits, a purchasing pool and government-sponsored reinsurance. These measures in themselves do not yield universal coverage, nor would an employer mandate. The building blocks and an employer mandate combined with an individual mandate would yield universal coverage with a relatively small increase in government costs relative to state GDP and current health spending. (www.roadmaptocoverage.com, June 21, 2005)

The Health Insurance Reform Simulation Model (HIRSM) is designed to simulate the coverage, cost, and tax implications of health insurance coverage expansion proposals and other reforms to the health insurance system. The model uses nationally representative data on employers, workers, and those outside of the labor market. HIRSM simulates the behavioral choices of insurers, employers, and individuals under the current system and under reform, allowing us to predict the coverage consequences of various policies. It can simulate the effects of reforms affecting private insurance markets and public programs. This report details the model in its entirety and presents prototypical results.

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