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The Fragmentation of U.S. Health CareCauses and Solutions$
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Einer Elhauge

Print publication date: 2010

Print ISBN-13: 9780195390131

Published to Oxford Scholarship Online: May 2010

DOI: 10.1093/acprof:oso/9780195390131.001.0001

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A More Equitable and Efficient Approach to Insuring the Uninsurable

A More Equitable and Efficient Approach to Insuring the Uninsurable

Chapter:
(p.221) 10 A More Equitable and Efficient Approach to Insuring the Uninsurable
Source:
The Fragmentation of U.S. Health Care
Author(s):

Eric Helland

Jonathan Klick

Publisher:
Oxford University Press
DOI:10.1093/acprof:oso/9780195390131.003.010

This chapter argues that although concern for individuals with relatively high expected health care costs may justify significant cross-subsidization on normative grounds, it makes sense as a matter of fairness and in terms of minimizing attendant efficiency losses to sever the employment link, enacting a program through which cross-subsidization occurs within society more generally. The chapter is organized as follows. Section 2 briefly reviews the literature on labor market distortions related to health insurance benefits. Section 3 discusses how many individuals are likely to be “uninsurable” in an insurance market in which coverage is not tied to a person's employer. Section 4 lays out the proposal to move individuals requiring subsidies to a broad-based pool financed through the federal tax system, and discusses the determinants of health insurance affordability and pricing mechanism. Section 5 discusses the necessary federalization of Medicaid and the abolition of state-level insurance mandates that accompany our proposal. Section 6 examines the experience of other countries in order to shed light on the efficacy of our proposal, and Section 7 concludes.

Keywords:   health care policy, health care costs, health insurance, cross-subsidization

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