Cost and coverage estimates for a national public health plan: A public health plan is included in reform proposals being considered by President Obama and Congress. A 12-page report by the Lewin Group provides estimates of the impact on cost and coverage based on differing levels of eligibility and provider reimbursement rates. For example, if Medicare payment levels are used, premiums would be up to 30% less than those for comparable private coverage. The average monthly premium for a typical benefits package would be $761 per family, compared with an average of $970 for the same coverage from private insurers. If, as President Obama has proposed, eligibility is limited to small employers, individuals, and the self-employed, enrollment would reach 42.9 million, and the number with private insurance would fall by 32 million. If private-payer reimbursement levels are used, enrollment would be lower, with only 10.4 million people switching to the public plan from private insurance. If the plan is open to all individuals and employers, as in some proposals, about 131.2 million persons would enroll at Medicare payment levels, and the number with private insurance would decline by 119.1 million—a two-thirds reduction from current levels. However, if private-payer levels are used, enrollment in private insurance would decline by only 12.5 million. If Medicare reimbursement rates and eligibility are used for all individuals and employers, provider net income would decline under the plan. Net hospital revenues would fall by $36 billion (4.6%), and physician net income would fall by $33 billion (6.8%). If eligibility is restricted to the individuals and small firms in the Obama proposal, net hospital revenues would increase by $11.3 billion and net physician incomes would decline by $3 billion. The Cost and Coverage Impacts of a Public Plan: Alternative Design Options is available at www.lewin.com.