Rewrite insurance & benefits law

Effective in stages with each enrollment wave · Congress; DOL EBSA; Treasury; state insurance commissionersDiscuss this step

How other countries handled this same piece of implementation, what happened, and what it means for this plan.

Side by side

Country	Approach	Result	Lesson for this plan
This plan (U.S.)	Amend ERISA, the tax code, and the ACA so that employer plans and private insurance cannot duplicate UHP benefits, and so supplementary insurance is regulated.
Canada	Provinces ban or restrict private insurance for publicly insured services. Quebec's ban was struck down in Chaoulli (2005) because waits were unreasonable; Quebec allowed private insurance for a few procedures.	Single tier for covered services; ongoing legal challenges (Cambie, B.C., 2020–24, upheld the ban).	A ban survives court only if public waits are reasonable, hence the wait guarantee.
Australia	Private duplicative insurance encouraged by the Medicare Levy Surcharge and rebates; about 45% hold private hospital cover.	Private patients avoid public queues; public elective waits remain long.	Private insurance shortens waits for those who buy it, not for everyone.
Ireland	About half the population buys private insurance to skip public waiting lists.	Among the longest public waits in Europe; Sláintecare reform aims to remove private care from public hospitals.	A large private tier inside public hospitals worsens public waits.

What they did: Provinces ban or restrict private insurance for publicly insured services. Quebec's ban was struck down in Chaoulli (2005) because waits were unreasonable; Quebec allowed private insurance for a few procedures.
What happened: Single tier for covered services; ongoing legal challenges (Cambie, B.C., 2020–24, upheld the ban).
Lesson for this plan: A ban survives court only if public waits are reasonable, hence the wait guarantee.

What they did: Private duplicative insurance encouraged by the Medicare Levy Surcharge and rebates; about 45% hold private hospital cover.
What happened: Private patients avoid public queues; public elective waits remain long.
Lesson for this plan: Private insurance shortens waits for those who buy it, not for everyone.

What they did: About half the population buys private insurance to skip public waiting lists.
What happened: Among the longest public waits in Europe; Sláintecare reform aims to remove private care from public hospitals.
Lesson for this plan: A large private tier inside public hospitals worsens public waits.