Mandatory Health Reform

All of these approaches retain a role for private health insurance, but differ in their degree of government regulation and involvement in the health insurance system.  While all are designed to achieve universal health coverage, they are listed in approximate order of the degree of government involvement in perfecting health insurance or health services markets.

  1. Responsible National Health Insurance proposed by Mark Pauly, Patricia Danzon, Paul Feldstein and John Hoff. [Health Affairs Paper (1991)][Book]. [CBO analysis (1994)]
  2. The Heritage Proposal by Stuart Butler and Edward Haislmaier. [CBO analysis (1994)]
  3. Major Risk Insurance proposed by Martin Feldstein and Jonathan Gruber.
  4. Health Care Vouchers proposed by Ezekiel Emanuel and Victor Fuchs.
  5. Progressive Cost-Sharing proposal by Jason Furman.
  6. Baucus (Senate Finance Committee) Plan
  7. Wyden-Bennett Healthy Americans Act
  8. Rockefeller Consumer Health Choices Act
  9. Kennedy (Senate HELP Committee) Plan
  10. Rangel (House Ways and Means Committee) Plan

The use of mandates to achieve social policy objectives is not uncommon. A 2013 CBO review concluded:

  • Of the nearly 9,000 legislative proposals for which CBO has prepared mandate statements since UMRA (Unfunded Mandates Reform Act) was enacted, 16 percent contained private-sector mandates.
  • Among the proposals with mandates, 25 percent were estimated to result in total annual costs for private-sector mandates that would exceed the UMRA threshold (originally $100 million; $150 million in 2013 with inflation adjustment), and 59 percent were estimated to impose mandate costs below the threshold. The other 16 percent included mandates whose total costs could not be determined, generally because the scope of a particular mandate would not be known until specific regulations were issued.
  • Between 2001 and 2011, lawmakers enacted roughly 2,300 public laws; 12 percent of them contain at least one mandate on the private sector. Of the laws with mandates, 26 percent include at least one mandate whose annual costs were estimated to exceed the UMRA threshold sometime in the first five years, 57 percent impose mandates whose total annual costs were below the threshold, and 17 percent contain mandates whose costs could not be estimated.
  • Put another way, about 3 percent of all public laws enacted during the 2001–2011 period contain at least one private-sector mandate whose annual costs were estimated to exceed the UMRA threshold sometime in the first five years, 7 percent include mandates with costs below the threshold, and 2 percent impose mandates whose costs could not be determined.

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