NCPA - National Center for Policy Analysis


September 15, 2008

At any one time as many as 46 million Americans lack health insurance.  What should we do about that?  John C. Goodman, president of the National Center for Policy Analysis and his colleagues have been studying this problem for 25 years and they have created proposals which have been championed by both Republicans and Democrats, liberals and conservatives.  Below is a brief summary.

Give everyone a health savings account: 

  • Every individual should be able to deposit up to $200 into a tax-free health savings account (HSA) every month.
  • Employers should be encouraged to automatically enroll their employees in a HSA.

Give all private health insurance the same tax break:

  • Currently, the federal government "spends" about $250 billion a year on tax subsidies for private insurance, so the government is paying almost half the cost of a middle-income family's insurance.
  • The solution is to subsidize all insurance uniformly; people should receive the same tax advantage for the purchase of insurance, regardless of how it is obtained.

Give every family the same tax break:

  • Ideally, a uniform, refundable tax credit should be offered to every individual for the purchase of private insurance.
  • An example is McCain's proposal to offer a tax credit of $2,500 (individual) or $5,000 (family).

Give people alternatives to Medicaid and SCHIP:

  • When people enroll in Medicaid and SCHIP plans that pay Medicare rates they have far fewer options.
  • The solution is to reverse the process, making it as easy as possible for people to use their Medicaid dollars to enroll in employer plans and other private insurance.

Return to the idea of offering every family $5,000:

  • This amount should be reserved for healthcare, regardless of the family's choice.
  • If the family stays uninsured, the subsidy should go to a local safety net institution that will be called on to provide free care if the family cannot pay for it.

Source: John C. Goodman, "Insuring the uninsured," Star-Telegram, September 15, 2008.


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