Journal of Economic Perspectives: Vol. 22 No. 4 (Fall 2008)


Quick Tools:

Print Article Summary
Export Citation
Sign up for Email Alerts Follow us on Twitter


JEP - All Issues

Incremental Universalism for the United States: The States Move First?

Article Citation

Gruber, Jonathan. 2008. "Incremental Universalism for the United States: The States Move First?" Journal of Economic Perspectives, 22(4): 51-68.

DOI: 10.1257/jep.22.4.51


The latest wave of health care proposals and laws in the United Sates has been marked by what I call "incremental universalism" -- that is, getting to universal health insurance coverage by filling the gaps in the existing system, rather than ripping up the system and starting over. In this paper, I provide an overview of "incremental universalism" as an approach to healthcare reform, explore the issues it raises, and examine how these issues are being addressed at the state level, focusing primarily on the healthcare reform plan enacted by Massachusetts in April 2006. This sweeping bill altered insurance markets, subsidized insurance coverage for a large swath of the population, introduced a new health insurance purchasing mechanism (the "Connector"), and mandated insurance coverage for almost all citizens. The Massachusetts experience has led to similar proposals in a number of states, including a major (but ultimately failed) effort in California. I am far from an objective observer in discussing the Massachusetts law. I was one of the architects of the law and since 2006 have been a member of the board overseeing its implementation. Despite this bias and the fact that the ambitious Massachusetts plan is still in relatively early stages of implementation, I can say that some early results point to major successes for this reform.

Article Full-Text Access

Full-text Article (Complimentary)


Gruber, Jonathan (MIT and Massachusetts Board of the Commonwealth Health Insurance Connector Authority)

JEL Classifications

H51: National Government Expenditures and Health
I18: Health: Government Policy; Regulation; Public Health
H75: State and Local Government: Health, Education, and Welfare


View Comments on This Article (0) | Login to post a comment

Journal of Economic Perspectives

Quick Tools:

Sign up for Email Alerts

Follow us on Twitter

Subscription Information
(Institutional Administrator Access)


JEP - All Issues

Virtual Field Journals

AEA Member Login:

AEAweb | AEA Journals | Contact Us