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Incremental Universalism for the United States: The States Move First?

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  • Jonathan Gruber
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    Abstract

    The latest wave of health care proposals and laws in the United Sates has been marked by what I call "incremental universalism" -- that is, getting to universal health insurance coverage by filling the gaps in the existing system, rather than ripping up the system and starting over. In this paper, I provide an overview of "incremental universalism" as an approach to healthcare reform, explore the issues it raises, and examine how these issues are being addressed at the state level, focusing primarily on the healthcare reform plan enacted by Massachusetts in April 2006. This sweeping bill altered insurance markets, subsidized insurance coverage for a large swath of the population, introduced a new health insurance purchasing mechanism (the "Connector"), and mandated insurance coverage for almost all citizens. The Massachusetts experience has led to similar proposals in a number of states, including a major (but ultimately failed) effort in California. I am far from an objective observer in discussing the Massachusetts law. I was one of the architects of the law and since 2006 have been a member of the board overseeing its implementation. Despite this bias and the fact that the ambitious Massachusetts plan is still in relatively early stages of implementation, I can say that some early results point to major successes for this reform.

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    File URL: http://www.aeaweb.org/articles.php?doi=10.1257/jep.22.4.51
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    Bibliographic Info

    Article provided by American Economic Association in its journal Journal of Economic Perspectives.

    Volume (Year): 22 (2008)
    Issue (Month): 4 (Fall)
    Pages: 51-68

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    Handle: RePEc:aea:jecper:v:22:y:2008:i:4:p:51-68

    Note: DOI: 10.1257/jep.22.4.51
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    1. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, Elsevier, vol. 23(5), pages 1059-1082, September.
    2. Roger Feldman & Kenneth E. Thorpe & Bradley Gray, 2002. "Policy Watch: The Federal Employees Health Benefits Plan," Journal of Economic Perspectives, American Economic Association, American Economic Association, vol. 16(2), pages 207-217, Spring.
    3. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, American Economic Association, vol. 77(3), pages 251-77, June.
    4. Jonathan Gruber, 2004. "Tax Policy for Health Insurance," NBER Working Papers 10977, National Bureau of Economic Research, Inc.
    5. Gruber, Jonathan & Washington, Ebonya, 2005. "Subsidies to employee health insurance premiums and the health insurance market," Journal of Health Economics, Elsevier, Elsevier, vol. 24(2), pages 253-276, March.
    6. Ilayperuma Simon, Kosali, 2005. "Adverse selection in health insurance markets? Evidence from state small-group health insurance reforms," Journal of Public Economics, Elsevier, Elsevier, vol. 89(9-10), pages 1865-1877, September.
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    Cited by:
    1. Charles J. Courtemanche & Daniela Zapata, 2012. "Does Universal Coverage Improve Health? The Massachusetts Experience," NBER Working Papers 17893, National Bureau of Economic Research, Inc.

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