Until recently, quite a few health care reformers wanted to restructure the world of healthcare so that it would return to some level of entirely mythical “the good old days” where Marcus Welby-like physicians knew everything about every patient and made great, science-based decisions for each one without interference from anything like health plans or government regulations. But everyone now knows that such an approach would be costly, and it could create a real quality chasm to cross.

Fortunately, a wide range of people are ready for someone to design and build a bridge across that chasm. This reform package fills that role by extending coverage to many more Americans, while laying out a framework for keeping costs under control. It also strengthens the financial security of those already insured, and it puts our budgetary and economic houses on a much more stable foundation.

Coverage gains: This reform extends marketplace subsidies to all legally present U.S. residents and establishes limited autoenrollment for the most disadvantaged households. As a result, it increases marketplace enrollment by about 2 million and lowers household-paid premiums by more than 800,000 people. It also lowers nongroup marketplace provider payment rates, resulting in fewer out-of-pocket expenses for consumers and reduced cost-sharing subsidy payments from the federal government. Federal spending: Federal costs increase slightly less than under Reform 1, largely because of the lower marketplace premiums and reduced out-of-pocket expenses.

The Congressional Budget Office (CBO) estimates that this reform package would reduce the number of uninsured by 24 million, to 6.6 million—a nearly 80 percent reduction compared with current law. It increases enrollment in the nongroup market by 30.8 million, with about 80 percent of enrollees receiving federal financial assistance.