In recent years, employer-sponsored health insurance has been eroding. An increasing number of working adults are without health insurance coverage, and forecasts indicate continuing declines in coverage. To reverse these trends and expand coverage for workers and their families, a range of public and private policy options are under discussion. The approaches vary in the extent to which they would build on the employment-based system, adapt the non-group or individual market, or expand public programs. Many health coverage expansion policies would combine public and private approaches. Proposals in the 109th Congress address four major options: expansion of tax credits; creation of new federal-state roles in regulating insurance markets; expansion of purchasing options for small firms; and expansion of public programs for the under-65 population.
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