Could we have covered more people at less cost? Technically, yes; politically, probably not.
The process by which Congress considers legislation rarely affords the public an opportunity to examine how the outcomes might change if components of the law were structured differently. We evaluated how the recently enacted health reform law performed relative to a large number of alternative designs on measures of effectiveness and efficiency. We found that only a few different approaches would produce both more newly insured people and a lower cost to the government. However, these are characterized by design options that seemed political untenable, such as higher penalties, lower subsidies, or less generous Medicaid expansion.
RAND Health, Santa Monica, California, USA. mcglynn@rand.org
Elizabeth A
EA
McGlynn
Amado
A
Cordova
Jeffrey
J
Wasserman
Federico
F
Girosi
D035082:Federal Government; D017048:Health Care Costs / Q000331:legislation & jurisprudence*; D018166:Health Care Reform / Q000191:economics / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence; D017057:Medically Uninsured / Q000331:legislation & jurisprudence; D009310:National Health Insurance, United States / Q000191:economics / Q000331:legislation & jurisprudence; D011057:Politics; D014481:United States