Why are results so tough under a tax scheme? According to Gruber, many already-insured individuals would likely take the new benefit, increasing the cost of the program. And Employee Benefits Research Institute (EBRI) official Paul Fronstin, PhD, tells WebMD that tax-based plans would have only a small impact, since individuals would face the hurdle of still having to shell out money for part of their own coverage.
Fronstin noted that although the federal CHIP insurance program is free for lower-income children, "They're having trouble giving it away." More than 10 million children lack health insurance, but about half of them are eligible for free federal coverage.
No matter what policymakers try, whittling down the numbers of those without coverage is a bear of a challenge. With 18% of the nonelderly now uninsured, "The best we're going to do is about 15%," said Fronstin.
But Marilyn Moon, PhD, a senior fellow at the nonprofit Urban Institute, is more optimistic that federal policy can beat down the numbers. "It's not going to go to zero, and it's not going to be easy to get it to 10%, but I do think we could do better than 15%," she tells WebMD.
A report issued earlier last month by the Institute for the Future and the Robert Wood Johnson Foundation gave a middle-of-the-road forecast that 48 million Americans would be uninsured by 2010, the same percentage of the nonelderly population as today. The report's alternative blue-sky prediction was for 30 million uninsured -- 11.5% of the nonelderly populace -- while its pessimistic alternative estimated that 65 million -- 25% -- would be without insurance.
While getting coverage for the uninsured is a complex nut to crack, coverage appears strong for the rest of the population. The country's robust economy is keeping many employers from dropping health insurance plans.
EBRI reported that the proportion of employed workers with health coverage has risen for the fifth straight year: Just under 65% of nonelderly Americans had coverage under an employer plan, the institute said.
"Employers are responding to the tight labor market," Fronstin noted, although he expressed "concern" that medical inflation is on the rise.