Specifically, a Medicare-for-All proposal could shift as many as 329M Americans to public coverage over time, while a “Buy-In” or public option approach may impact far fewer, between 177M and 43M.

“When it comes to health reform proposals put forth by Democratic candidates, the details matter,” said Chris Sloan, associate principal at Avalere. “While many are still fine tuning their  approaches, there is a wide spectrum of potential impacts.”

Figure 1: Population Potentially Impacted by Democratic Healthcare Proposals by Current Source of Insurance, in Millions, 2019

“Policymakers exploring an expansion of public programs have a fundamental choice in terms of eligibility,” said Elizabeth Carpenter, Head of Advisory Services at Avalere. “In particular, deciding to change the approach to employer-sponsored insurance alone could impact as many as 152 million Americans.”

Today, a plurality of the population, 46%, receives their insurance through their employer, with an additional 39% receiving their coverage through Medicare or Medicaid, and 9% of Americans remaining uninsured (Table 1). Any policy that contains substantial changes to public programs or employer sponsored insurance would change significantly the coverage landscape in the U.S.

Methodology

To conduct the analysis, Avalere utilized the estimated sources of health insurance coverage in the United States in 2019 from the proprietary Avalere All-Payer Enrollment Model. Importantly, this analysis does not project the impacts of any particular policies. Rather, by breaking down the sources of insurance coverage in the United States today, the analysis provides the various categories of insurance that may be impacted by the spectrum of proposals.