PROLOGUE: The growing number of uninsured Americans,
coupled with a fraying of the health care safety net, poses a
threat to the nation’s health. Even in the best of economic
times, a substantial percentage of the U.S. population of 270
million people is uninsured, a societal problem that has yet to
fully provoke the health policy community to act. The Clinton
administration’s comprehensive solution was flatly rejected;
thus, the president and Congress have returned to the politics
of incrementalism. The administration and Republicans on
Capitol Hill are expressing greater interest in encouraging the
purchase of private health insurance through tax credits, an
approach that President Bill Clinton proposed in his recent
long-term care plan. However, requiring that people purchase
coverage is an unresolved but ticklish issue for Republicans,
who fear that such an approach would be regarded as a tax
increase. Basic questions remain, though, about why health
insurance coverage has eroded over the past twenty years, and
that is the subject that Richard Kronick and Todd Gilmer
address in this paper.