RESEARCH

Healthcare Platforms of the Presidential Candidates

PARTY AFFILIATION

Democrat

Republican

• Eventual universal healthcare through newly established public programs, extensions of old programs and integration of the private insurance industry.
• Competition, via new insurance markets, and a technology overhaul to decrease costs and increase the quality of healthcare.

• Increase affordability of health insurance through competition between insurers.
• Emphasis on a variety of insurance options and giving people more control of buying and choosing insurance plans.
• Increase insurance portability so that individuals do not fear loss of insurance from job-to-job.

NEW HEALTH INSURANCE INITIATIVES
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• Establish a new public health insurance plan.
  • with guaranteed eligibility; cannot be denied coverage due to a pre-existing condition.
  • Benefits will be similar to that of the Federal Employees Health Benefits Program (FEHBP) .
  • Those who do not qualify for Medicaid or SCHIP will receive an income-related federal subsidy to purchase the new public plan or a private plan.
  • Plans will be portable without fear of lost insurance when moving from job-to-job. Establish the National Health Insurance Exchange
  • Watchdog group that monitors standards for participating insurers.
  • All insurers within the exchange must provide every applicant a policy, regardless of the applicant's health status.
  • All plans must be as generous as the public plan.
  • Costs and differences between plans must be made public.

• Promote and expand Health Savings Accounts (HSA); allowing families to spend their money on insurance that suits their needs (i.e. no unnecessary options)
  • HSAs are tax-advantaged accounts that people with high-deductible health plans (HDHP) can contribute money to and later use in case of a medical event
• Provide a $2500/$5000 refundable tax credit for individuals/families with health insurance
  • Encourage employees to buy their own insurance policies by paying the tax credit directly to the insurer.
• Anything left over from the tax credit can be applied to an HAS.
• Employees that like their original plans will able to keep them.
• Establish a Guaranteed Access Plan (GAP)
  • Allow states to decide how best to give its people ample insurance opportunities
• Example: establish non-profit corporation that contracts with insurers to provide insurance for those previously uninsured (limits on premiums and provisions only available below a certain income level).
• Federal assistance possible for non-profit GAP that has a board consisting of all stakeholders groups –legislators, insurers, business and medical community representatives, and patients.

IMPROVING THE QUALITY OF HEALTHCARE SYSTEMS

• Encourage team care and coordination for those with chronic conditions.
• Hospitals and providers required to report healthcare costs and quality.
  • Hospitals to disclose data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care.
  • Health plans to disclose percentage of premiums that go to patient care against administrative costs.
• Establish an independent institute to provide doctors with new information in order to make better decisions for patients via “comparative effectiveness research.”
• Provide for quality measurement and reporting, patient navigation programs, and diversification of the health workforce in order to remedy disparities in minorities’ healthcare.
• Force insurers to pay “reasonable” share of premiums for patient care.

• Need for coordinated care and bundled payments, particularly for patients with chronic diseases.
• Need for transparency so that patients can see where their money is going.
• Allow doctors to work across states (“national market place” for doctors).
• Doctors need to use technology to share “best practices” for dealing with health issues.
• Provide public with more information on treatment options.
• Promote education on health, nutrition and exercise, including smoking cessation programs.

COST CONTAINMENT
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• Allow Americans to buy cheaper drugs from outside the United States.
• Repeal ban that prevents Medicare from negotiating prices with drug companies.
• Use of generics for Medicare, Medicaid, and FEHBP.
• Prevent large drug companies from discouraging competition from generic drug makers.
• Strengthen funding for biomedical research to improve disease prevention, early detection, and therapy.
• Strengthen anti-trust laws to reduce physicians’ malpractice insurance.
• National Health Exchange expected to increase competition between insurers.
• Support and utilize proven disease management programs.
• Provide federal reinsurance to employers for unexpected or catastrophic illnesses, above a certain threshold, on a guarantee that savings are used to reduce the cost of workers’ premiums.
• Begin the widespread adoption of health information technology.

• Allow insurance to be bought from any willing provider.
  • Nationwide insurance market will increase competition and reduce costs (i.e. “excess costs, overhead, and bloated executive compensation”)
  • Allow churches and other professional organizations to sponsor insurance.
• Continuing care similar to state-based programs such as Cash and Counseling or The Program of All-Inclusive Care for the Elderly People.
  • Seniors given monthly stipend to use as they see fit.
  • Others (friends, family) can help manage what kind of care they receive; plans offer counseling and bookkeeping services.
• Walk-in clinics at retail stores for convenience and price.
• Reduce frivolous lawsuits (i.e. against those who follow clinical guidelines and adhere to patient safety protocols.)
• Safe re-importation of drugs.
• Encourage faster introduction of generic drugs.
• Competition between doctors and insurers will lead to lower premiums for both.

CHANGES IN PUBLIC PROGRAMS

• Insurers that are part of the new public plan, National Health Insurance Exchange, Medicare, and FEHBP are rewarded by the government only for quality, not quantity of services.
• Eliminate excessive subsidies to Medicare Advantage; pay the private insurers the same as Medicare costs.
• Expand eligibility of Medicaid and SCHIP.

• Revamp Medicare and Medicaid.
  • Change payment strategy for providers (Remove incentives for doctors to perform complex and costly services.)
  • Focus attention on chronic disease.
  • No payment for preventable medical errors.
• Veterans given control of their medical expenses so that they would not need to go to a VA facility in order to get care.

ROLE OF EMPLOYERS
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• Employers must offer “meaningful” contributions to the cost of health coverage or be required to contribute a percentage of payroll towards the cost of the public plan.
• Small employers that meet certain thresholds will be exempt.

• No provision for employer-based insurance requirement.
• Eliminate the tax-exclusion incentive for employer-based insurance and replace it with the tax credit for all individuals who have health insurance.

REQUIREMENTS FOR INDIVIDUALS TO HAVE HEALTH COVERAGE

• Eventual universal healthcare by the end of presidential term.
• Mandatory coverage of children, with dependants insurable by parents until the age of 25.

• No provision for mandatory coverage.

FINANCING

• Standards-based electronic health information systems expected to save billions over paper files and lost records.
• Money saved with new initiatives will cover the costs of the programs.
• Discontinuation of tax cuts for those with incomes over $250,000.

• In order to fund the tax credit, McCain proposes eliminating the current employer-sponsored health insurance tax exemption.