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Insuring the Uninsured: Options and Analysis

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Insuring the Uninsured: Options and Analysis [COMMITTEE PRINT] INSURING THE UNINSURED: OPTIONS AND ANALYSIS PREPARED FOR THE SUBCOMMITTEE ON LABOR-MANAGEMENT RELATIONS AND THE SUBCOMMITEE ON LABOR STANDARDS OF THE COMMITTEE ON EDUCATION AND LABOR AND THE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES AND THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE BY THE Congressional Research Service Library of Congress OCTOBER 1988 Education and Labor Serial No. 100-DD Energy and Commerce Serial No. 100-BB Special Committee on Aging Serial No. 100-0 [COMMITTEE PRINT] INSURING THE UNINSURED: OPTIONS AND ANALYSIS PREPARED FOR THE SUBCOMMITTEE ON LABOR-MANAGEMENT RELATIONS AND THE SUBCOMMITTEE ON LABOR STANDARDS OF THE COMMITTEE ON EDUCATION AND LABOR AND THE SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT OF THE COMMITTEE ON ENERGY AND COMMERCE HOUSE OF REPRESENTATIVES AND THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE BY THE Congressional Research Service Library of Congress OCTOBER 1988 Education and Labor Serial No. 100-DD Energy and Commerce Serial No. 100-BB Special Committee on Aging Serial No. 100-0 U.S. GOVERNMENT PRINTING OFFICE 90-441 ± WASHINGTON : 1988 For Sale by the Superintendent of Documents, Congressional Sales Office U.S. Government Printing Office, Washington, D.C. 20402 90-441 0 - 88 - 1 COMMITEE ON EDUCATION AND LABOR AUGUSTUS F. HAWKINS, California, Chairman WILLIAM D. FORD, Michigan JAMES M. JEFFORDS, Vermont JOSEPH M. GAYDOS, Pennsylvania WILLIAM F. GOODLING, Pennsylvania WILLIAM (BILL) CLAY, Missouri E. THOMAS COLEMAN, Missouri AUSTIN J. MURPHY, Pennsylvania THOMAS E. PETRI, Wisconsin DALE E. KILDEE, Michigan MARGE ROUKEMA, New Jersey PAT WILLIAMS, Montana STEVE GUNDERSON, Wisconsin MATTHEW G. MARTINEZ, California STEVE BARTLETI, Texas MAJOR R. OWENS, New York THOMAS J. TAUKE, Iowa CHARLES A. HAYES, Illinois RICHARD K. ARMEY, Texas CARL C. PERKINS, Kentucky HARRIS W. FAWELL, Illinois THOMAS C. SAWYER, Ohio PAUL B. HENRY, Michigan STEPHEN J. SOLARZ, New York FRED GRANDY, Iowa ROBERT E. WISE, Ja., West Virginia CASS BALLENGER, North Carolina TIMOTHY J. PENNY, Minnesota BILL RICHARDSON, New Mexico TOMMY F. ROBINSON, Arkansas PETER J. VISCLOSKY, Indiana CHESTER G. ATKINS, Massachusetts JAMES JONTZ, Indiana SuBcoMMITTEE ON LABOR-MANAGEMENT RELATIONS WILLIAM (BILL) CLAY, Missouri, Chairman WILLIAM D. FORD, Michigan MARGE ROUKEMA, New Jersey DALE E. KILDEE, Michigan RICHARD K. ARMEY, Texas CHARLES A. HAYES, Illinois HARRIS W. FAWELL, Illinois MAJOR R. OWENS, New York CASS BALLENGER, North Carolina JAMES JONTZ, Indiana THOMAS E. PETRI, Wisconsin AUSTIN J. MURPHY, Pennsylvania JAMES M. JEFFORDS, Vermont THOMAS C. SAWYER, Ohio (Ex-Officio) AUGUSTUS F. HAWKINS, California (Ex-Officio) SUBCOMMITTEE ON LABOR STANDARDS AUSTIN J. MURPHY, Pennsylvania, Chairman PAT WILLIAMS, Montana THOMAS E. PETRI, Wisconsin TIMOTHY J. PENNY, Minnesota STEVE BARTLETT, Texas ROBERT E. WISE, JR., West Virginia JAMES M. JEFFORDS, Vermont TOMMY F. ROBINSON, Arkansas (Ex-Officio) AUGUSTUS F. HAWKINS, California (Ex-Officio) COMMITTEE ON ENERGY AND COMMERCE JOHN D. DINGELL, Michigan, Chairman JAMES H. SCHEUER, New York NORMAN F. LENT, New York HENRY A. WAXMAN, California EDWARD R. MADIGAN, Illinois PHILIP R. SHARP, Indiana CARLOS J. MOORHEAD, California JAMES J. FLORIO, New Jersey MATTHEW J. RINALDO, New Jersey EDWARD J. MARKEY, Massachusetts WILLIAM E. DANNEMEYER, California THOMAS A. LUKEN, Ohio BOB WHITTAKER, Kansas DOUG WALGREN, Pennsylvania THOMAS J. TAUKE, Iowa AL SWIFT, Washington DON RITTER, Pennsylvania MICKEY LELAND, Texas DAN COATS, Indiana CARDISS COLLINS, Illinois THOMAS J. BLILEY, JR., Virginia MIKE SYNAR, Oklahoma JACK FIELDS, Texas W.J. (BILLY) TAUZIN, Louisiana MICHAEL G. OXLEY, Ohio RON WYDEN, Oregon HOWARD C. NIELSON, Utah RALPH M. HALL, Texas MICHAEL BILIRAKIS, Florida DENNIS E. ECKART, Ohio DAN SCHAEFER, Colorado WAYNE DOWDY, Mississippi JOE BARTON, Texas BILL RICHARDSON, New Mexico SONNY CALLAHAN, Alabama JIM SLATTERY, Kansas GERRY SIKORSKI, Minnesota JOHN BRYANT, Texas JIM BATES, California RICK BOUCHER, Virginia JIM COOPER, Tennessee TERRY L. BRUCE, Illinois SuacommrrrEE ON HEALTH AND THE ENVIRONMENT HENRY A. WAXMAN, California, Chairman JAMES H. SCHEUER, New York EDWARD R. MADIGAN, Illinois DOUG WALGREN, Pennsylvania WILLIAM E. DANNEMEYER, California RON WYDEN, Oregon BOB WHITTAKER, Kansas GERRY SIKORSKI, Minnesota THOMAS J. TAUKE, Iowa JIM BATES, California DAN COATS, Indiana TERRY L. BRUCE, Illinois THOMAS J. BLILEY, JR., Virginia MICKEY LELAND, Texas JACK FIELDS, Texas CARDISS COLLINS, Illinois NORMAN F. LENT, New York, RALPH M. HALL, Texas (Ex Officio) WAYNE DOWDY, Mississippi JOHN D. DINGELL, Michigan, (Ex Officio) SPECIAL COMMITTEE ON AGING JOHN MELCHER, Montana, Chairman JOHN GLENN, Ohio JOHN HEINZ, Pennsylvania LAWTON CHILES, Florida WILLIAM S. COHEN, Maine DAVID PRYOR, Arkansas LARRY PRESSLER, South Dakota BILL BRADLEY, New Jersey CHARLES E. GRASSLEY, Iowa QUENTIN N. BURDICK, North Dakota PETE WILSON, California J. BENNETT JOHNSTON, Louisiana PETE V. DOMENICI, New Mexico JOHN B. BREAUX, Louisiana JOHN H. CHAFEE, Rhode Island RICHARD SHELBY, Alabama DAVE DURENBERGER, Minnesota HARRY REID, Nevada ALAN K. SIMPSON, Wyoming COMMITTEE ON EDUCATION AND LABOR U.S. HOUSEOF REPRESENTATIVES WASHINGTON.DC 20515 October 14, 1987 Mr. Joseph E. Ross, Director Congressional Research Service Library of Congress Washington, D. C. 20540 Dear Mr. Ross: Public and private institutions now provide health insurance to the majority of the nation's population. In general, most employed working-age persons and their dependents are covered through employer-provided insurance. The elderly and disabled are covered by the Federal government-s Medicare program and about two-fifths of the poor receive insurance through the Federal/State Medicaid program. However, a sizeable minority (estimates run as high as 37 million) have no health insurance even though most of these are employed. Furthermore, some 10 million people in poverty are not covered by Medicaid and have no health insurance. Various means to extend health insurance coverage to those who do not have it have been proposed in the past, and although some improvements have been made, the largest part of the problem still remains. This Committee is interested in further efforts to extend coverage to those who do not now have it, and we are writing to you to solicit the assistance of the Congressional Research Service in analyzing options for doing so. In particular, the Committee is interested in options for extending minimum health benefits to those who do not have health insurance as part of compensation for employment. This might be by providing incentives to employers, by mandating coverage, or some other means. In addition, the Committee is interested in options for providing insurance to those who are either unemployed, are uninsurable through current practices, or who are poor and yet do not qualify for Medicaid. Mr. Joseph E. Ross October 14, 1987 We recognize this to be a difficult task and are in need of high quality analysis to assist us. Accordingly, we are requesting the CRS to provide the Congress with analysis on the costs of the various options for mandating health insurance, on individuals, on businesses, and on other public and private institutions. In addition, we request that the analysis include consideration of some of the administrative issues associated with options for extending health insurance to those who do not have it. We thank you for your support. Sinceply, Austin Murphy wkins Chairman Chairman Subcommittee on Labor Standards William L. Clay Chairman Subcommittee on Labor- Management Relations VII U.S. HOUSE OF REPRESENTATIVES LMi.M.- COMMITTEE ON ENERGYAND COMMERCE owTS SUBCOMMITTEE ON HEALTH AND THE ENVIRONMENT 2415 RAYSURNHOUSE OFFICE BUILDING WASHINGTON. DC 20515 MIOD2220052 March 30, 1988 Mr. Joseph Ross, Director Congressional Research Service Library of Congress Washington, D.C. 20540 Dear Mr. Ross: I understand the Congressional Research Service is prepared to undertake a major study related to health insurance and the uninsured population in the U.S.: Who is Uncovered, what role private health insurance can play in providing coverage to the uninsured, options for extending that health insurance coverage, and the effects of a program to achieve this end. I am aware that the Committee on Education and Labor has worked with you on the design and plan for the study. With their agreement, I would like to request that you also consider the Committee on Energy and Commerce as a requester of the study, include us in the study development, and provide us with your results. My staff has already discussed the study plan in some detail with Royal Shipp and Janet Kline. We look forward to continuing to work with them as the study progresses. I believe it will provide great assistance to the Committee in its consideration of the Minimum Health Benefits bill, and will make an important contribution to our long-term understanding of and solution to the proolem of the uninsured. With every good wish, I am, Sincerely, HENRY A. Waxman Chairman, Subcommittee on Health and the Environment HAW:kna f1 VIII 551 Otan.OW Athtited20 tatest01 t0 SPECIALCOMMITTEE ON A(NG WASHINGTON,DC 2051 00 October 21, 1987 Joseph E. Ross Director Congressional Research Service Library of Congress Washington, DC 20540 Dear Mr. Ross: Public and private institutions now provide health insurance to the majority of the Nation's population. Most employed persons and their
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