Could We Have Covered More People at Less Cost?

Technically, Yes; Politically, Probably Not

Published In: Health affairs, v. 29, no. 6, June 2010, p. 1142-1146

Posted on RAND.org on December 31, 2009

by Elizabeth A. McGlynn, Amado Cordova, Jeffrey Wasserman, Federico Girosi

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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.

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