Katherine Swartz

Makes the case for greater government-led investments in education, physical infrastructure (particularly for transportation and electricity transmission), and alternative energy sources so the U.S. can maintain high levels of productivity in coming decades when more of the population will be 65 years old and older.

Describes four policy challenges related to changes in life circumstances that could affect insurance coverage: adjusting premium and cost-sharing subsidies when incomes change; coordinating eligibility for premium credits, Medicaid, and the Children's Health Insurance Program; encouraging and facilitating continuous coverage; and minimizing transitions between individual and small-business exchanges. Policy recommendations include extending coverage to the open enrollment period at the end of the year, generous treatment of income gains in correcting premium tax credits, and unifying the small-business and individual exchanges.

Examines the research on the effects of patient cost-sharing on health care spending and health outcomes, and argues that increasing patient cost-sharing is unlikely to dramatically slow health care spending because half the population is responsible for only 3% of all health care spending. The people whose health care expenses put them in the top 10% of the population account for 70% of all health care spending – and their health expenses exceed common thresholds for limits on required cost-sharing.

Documents the history of government programs designed to provide assistance with health care expenses for poor people – starting with programs that preceded Medicaid and going through to the Children’s Health Insurance Program and Community Health Centers. Efforts to reign in federal and state spending, as well as expansions of eligibility, are described. Concludes with a brief review of groups of poor people who are not helped by Medicaid and other programs – some of whom will be eligible for Medicaid under the Affordable Care Act.

Provides a summary of who lacks health insurance and reasons why, and then provides a blueprint for how the number of uninsured can be reduced. Most of the suggestions are embedded in the Affordable Care Act.

Documents the contraction of employer-based coverage and other reasons why middle-income as well as low-income Americans are losing affordable health insurance coverage.