The United States could achieve near-universal health coverage and decrease national health spending by working within our current public–private health system, according to new analysis published today by the Urban Institute and the Commonwealth Fund. 

Researchers modeled eight reforms and their potential effects on health care coverage, national health costs, and spending by federal and state governments, consumers, and employers. The plans fall along a continuum — from improvements to the Affordable Care Act (ACA) to a single-payer reform, similar to Medicare for All proposals, that would eliminate private insurance, cover all U.S. residents and undocumented immigrants, add new benefits like long-term care, and eliminate premiums and cost-sharing. Many of the proposals are similar to plans advanced by Democratic presidential candidates and members of Congress.

The new research shows that universal coverage and more affordable health costs are possible by building on the ACA. It also shows that a single-payer plan could be devised that achieves lower federal spending and overall costs compared to our current system. 

Also see our new calculator that tells you how overall personal health spending would change, on average, in your income group under four of the reform options. It also shows how the reforms would affect the number of uninsured, federal health spending, and additional revenues needed.