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Toy men looking at dotted lines on paper All health care reform solutions come with trade-offs of sorts; with increased coverage comes increased federal spending in most cases. (Image: Shutterstock)

The United States can achieve universal or near-universal insurance coverage with modest increases in federal spending, while still maintaining an employer-based insurance system, a new report concludes.

The study by the Commonwealth Fund looks at eight different possible paths forward to increase health care access in the U.S., including four versions that would enhance the existing Affordable Care Act (ACA); two that would allow employees to opt out of the private market and into a public option-type plan; and two single-payer systems that would eliminate private, employer-sponsored health plans. Only the last two would eliminate employer-based coverage completely—and the study’s authors said that costs to employers would go down with any of the reforms.

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