Today the U.S. Census Bureau released its annual estimate of the uninsured. For some, it came as a surprise that both the rate and number of people without health insurance actually declined, from 47 million, or 15.8% in 2006, to 45.7 million, or 15.3% in 2007. For those of us who follow the numbers closely, however, it’s no surprise.
While the rate and number of uninsured has fallen, this year’s Census shows the beginning of a startling trend. The percent of Americans with private health insurance is on the decline, mostly as a result of the steady erosion of employer-based coverage, while the percentage of Americans with government insurance is rising even faster, in large part due to Medicaid and SCHIP expansions at the state level and an aging population that is becoming increasingly reliant on Medicare. Thus, the current trend is toward government dependency.
This trend clearly indicates why the status quo is simply intolerable for conservatives.
So what, then, are the policy options?
- Continue to do nothing — and evolve toward a government-controlled health insurance system (see above).
- Try to resuscitate or mandate private, employer-based coverage (good luck).
- Support a “third way” that preserves and expands private coverage by evolving beyond the traditional model of employer-sponsored health insurance.
Instead of ignoring the issue of the uninsured entirely or relying on a flawed employer-based model of the past, federal and state policymakers should recognize the merits of a uniquely American path — a “third-way” — to health reform.
Under such an approach employers would have broader options and would not necessarily own and control health insurance. Instead they would have the flexibility to become facilitators of coverage by serving as the access point to personal, portable private health insurance plans. This way, patients — even those with low-incomes — would be the key decision makers in a competitive marketplace. Rethinking our insurance model, and evolving toward coverage that’s tied to the person and not the job, will better suit our increasingly dynamic economy where today working Americans overwhelmingly cycle in and out of coverage.
To enable employers to be facilitators, but not necessarily owners, of insurance policies, the federal government should move to reform the tax treatment of health insurance and transition to a system of health care tax credits. State governments could also do their part and fix their health insurance markets by establishing health insurance exchanges, where individuals and employees of small businesses could get access to personal, portable, private coverage while receiving the same favorable tax benefits that come with traditional employer-sponsored health insurance.