With gubernatorial elections coming up this November, health care is heating up as one of the key issues in many states. For example, California's Governor Arnold Schwarzenegger said he would make 2007 "the year of health care" if reelected.[1] Though it is not known how many campaign promises will actually be fulfilled after elections, candidates—both incumbents and challengers, Democrats and Republicans—have been outlining reforms that they say will improve the performance of the health care system. Their expressed goals include expansion of coverage and access to services, lower costs, improved efficiency, and better quality care.
While the reforms proposed by the candidates vary considerably in terms of strategy and specificity, a few major themes dominate the races.[2]
- Prescription Drug Discounts Many candidates are addressing public concerns about the rising cost of prescription drugs. They are calling for prescription discount cards for seniors and/or people without drug coverage (Democrats from AZ, GA, IL, NH, OR, and RI; Republicans from CA and MN) and importation of drugs from other nations (Democrat from KS), as well as general calls for "affordable Rx drugs."
- Children's Coverage Expansion Another common campaign promise is for expansion of health coverage for children. Candidates' proposals include expanding Medicaid, the State Children's Health Insurance Program (SCHIP), or state funding (or a combination of these) to children further up the income ladder (Democrats from AL and TN), or for "all kids" (Democrats from GA,OR, RI, and WI). The latter approach is modeled on Illinois' All Kids program—the first state program, implemented July 1, 2006, to offer affordable, comprehensive health insurance for every child (described in March 2006 States in Action).
- Consumerism A number of gubernatorial candidates are proposing various ways to enable consumers to take a more active role in health care and purchasing decisions. A few are promoting health savings accounts (Republicans from IA, MN, and OR). Many candidates are promising greater transparency of health care prices and quality through new information technologies (Republicans from CO, IA, IL, MI, MN, NH, and OR; Democrat from RI).
- Affordability for Small Businesses Candidates are addressing the lack of affordable health care for small businesses through a variety of approaches. They include calls for tax incentives or other types of financial assistance to small businesses (Democrats from AL, CT, MI, and SC); reinsurance programs that would indirectly reduce premiums for employers and employees (Democrats from AZ and RI); expansion of the state's medical insurance pool to small businesses and high-risk individuals (Republican from OR); less regulation of the private sector (Republican from NH); and other proposals. There was also a suggestion to promote the purchase of private health insurance by reducing Medicaid benefits so they are not more attractive than private insurance (Republican from NY).
- Universal Coverage While many candidates are supporting expansion of health coverage—whether through Medicaid, private insurance, a buy-in to state employee health coverage, or some combination (Democrats from AL, AR, and IA)—a small number of candidates are actually proposing "universal coverage for all families" in the state (Democrats from CA and CT). One candidate would develop a comprehensive plan modeled after Maine's Dirigo Health plan (Democrat from SD), another would use an individual mandate as in Massachusetts' recent health reform (Republican from OH), and a third candidate would use a single state risk pool to make access to health care continuously available to all residents, regardless of employment (Democrat from VT).
In addition to these themes that appear to be major election issues, numerous other health-related issues are being discussed by candidates in various states across the nation. They include, but are not limited to: preventive care and wellness, rural health care, medical liability reform, school-based clinics, community health centers, mental health, long-term care, stem cell research, and the nursing shortage.
Notes
[1] Health Care Emerging as Issue in Governor's Race, California Healthline, California Healthcare Foundation, June 12, 2006.
[2] Note: Democrat or Republican candidates from states listed in parentheses are examples based on campaign statements and materials; the lists are not exhaustive or fully up to date, since candidates' positions frequently change over time.
