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CRS Issue Statement on Health Care Reform
Chris L. Peterson, Coordinator
Specialist in Health Care Financing
January 14, 2010
Congressional Research Service
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www.crs.gov
IS40678
CRS Report for Congress
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repared for Members and Committees of Congress
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CRS Issue Statement on Health Care Reform

nterests in health care reform are driven by growing concern about several widely discussed
problems, most especially health insurance coverage, health care costs, and patients’ access to
I quality care. Commonly cited figures indicate that more than 46 million people have no
insurance, which can limit their access to care and their ability to pay for the care they receive.
Costs are rising for nearly everyone, and the country now likely spends over $2.6 trillion, more
than 16% of gross domestic product (GDP), on health care services and products, far more than
other industrialized countries. For all this spending, the country scores but average or somewhat
worse on many indicators of health care quality, and many may not get appropriate standards of
care.
These concerns raise significant challenges. Each of the concerns is more complex than might
first appear, which increases the difficulty of finding solutions. For example, by one statistical
measure, far more than 46 million people face the risk of being uninsured for short time periods,
yet by another, substantially fewer have no insurance for long periods. Insurance coverage and
access to health care are not the same, and it is possible to have one without the other. Having
coverage does not ensure that one can pay for care, nor does it always shield one from significant
financial loss in the case of serious illness. Similarly, high levels of spending may be partly
attributable to the country’s wealth, while rising costs, though difficult for many, may primarily
mean that less money is available for other things.
Solutions to these concerns may conflict with one another. For example, expanding coverage to
most of the uninsured would likely drive up costs (as more people seek care) and expand public
budgets (since additional public subsidies would be required). Cutting costs may threaten
initiatives to improve quality. Other challenges include addressing the interests of stakeholders
that have substantial investments in present arrangements and the unease some people have about
moving from an imperfect but known system to something that is potentially better but untried.
How much reform might cost and how to pay for it is also an issue.
Health care reform proposals often rekindle debate over perennial issues in American health care
policy. These include whether insurance should be public or private; whether employment-based
insurance should be strengthened, weakened, or left alone; what role states might play; and
whether Medicaid should be folded into new insurance arrangements. Whether changes to
Medicare should occur at the same time may also be considered. Concerns about coverage, cost
and spending, and quality are likely to be addressed within the context of these issues.

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CRS Issue Statement on Health Care Reform

Issue Team Members

Chris L. Peterson, Coordinator
Kathleen S. Swendiman
Specialist in Health Care Financing
Legislative Attorney
cpeterson@crs.loc.gov, 7-4681
kswendiman@crs.loc.gov, 7-9105
Erin D. Williams
Cliff Binder
Specialist in Public Health and Bioethics
Analyst in Health Care Financing
ewilliams@crs.loc.gov, 7-4897
cbinder@crs.loc.gov, 7-7965
Bernadette Fernandez
Patricia A. Davis
Analyst in Health Care Financing
Specialist in Health Care Financing
bfernandez@crs.loc.gov, 7-0322
pdavis@crs.loc.gov, 7-7362
Elicia J. Herz
Evelyne P. Baumrucker
Specialist in Health Care Financing
Analyst in Health Care Financing
eherz@crs.loc.gov, 7-1377
ebaumrucker@crs.loc.gov, 7-8913
Julie Stone
Angela Napili
Specialist in Health Care Financing
Information Research Specialist
jstone@crs.loc.gov, 7-1386
anapili@crs.loc.gov, 7-0135
Hinda Chaikind
Vanessa K. Burrows
Specialist in Health Care Financing
Legislative Attorney
hchaikind@crs.loc.gov, 7-7569
vburrows@crs.loc.gov, 7-0831
Jon O. Shimabukuro
Carol Rapaport
Legislative Attorney
Analyst in Health Care Financing
jshimabukuro@crs.loc.gov, 7-7990
crapaport@crs.loc.gov, 7-7329
Jennifer Staman
Julie M. Whittaker
Legislative Attorney
Specialist in Income Security
jstaman@crs.loc.gov, 7-2610
jwhittaker@crs.loc.gov, 7-2587
Cynthia Brougher
Nancy Lee Jones
Legislative Attorney
Legislative Attorney
cbrougher@crs.loc.gov, 7-9121
njones@crs.loc.gov, 7-6976
Jane G. Gravelle
Janet Kinzer
Senior Specialist in Economic Policy
Information Research Specialist
jgravelle@crs.loc.gov, 7-7829
jkinzer@crs.loc.gov, 7-7561
D. Andrew Austin
Sarah A. Lister
Analyst in Economic Policy
Specialist in Public Health and Epidemiology
aaustin@crs.loc.gov, 7-6552
slister@crs.loc.gov, 7-7320
Sibyl Tilson
C. Stephen Redhead
Specialist in Health Care Financing
Specialist in Health Policy
stilson@crs.loc.gov, 7-7368
credhead@crs.loc.gov, 7-2261
Barbara English
Amanda K. Sarata
Information Research Specialist
Analyst in Health Policy and Genetics
benglish@crs.loc.gov, 7-1927
asarata@crs.loc.gov, 7-7641
Jim Hahn
Kirsten J. Colello
Analyst in Health Care Financing
Specialist in Health and Aging Policy
jhahn@crs.loc.gov, 7-4914
kcolello@crs.loc.gov, 7-7839
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CRS Issue Statement on Health Care Reform

Marc Labonte
Janemarie Mulvey
Specialist in Macroeconomic Policy
Specialist in Aging Policy
mlabonte@crs.loc.gov, 7-0640
jmulvey@crs.loc.gov, 7-6928
Paulette C. Morgan
Susan Thaul
Specialist in Health Care Financing
Specialist in Drug Safety and Effectiveness
pcmorgan@crs.loc.gov, 7-7317
sthaul@crs.loc.gov, 7-0562
Holly Stockdale
Bernice Reyes-Akinbileje
Analyst in Health Care Financing
Analyst in Health Resources and Services
hstockdale@crs.loc.gov, 7-9553
breyes@crs.loc.gov, 7-2260


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