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Presidential Candidates' Health Care Reform Proposals

Continuing our reporting of presidential candidates' health reform strategies, this issue summarizes two proposals released in October, by Senator Joe Biden (D-Delaware) and Senator John McCain (R-Arizona).

Senator Biden's CARE plan
Under his "CARE" health reform plan, Senator Biden would take four steps toward universal health coverage. The plan is estimated to cost $80 to $120 billion per year and would be financed by eliminating tax cuts, including those for the wealthiest 1 percent of the population. It features expansion of public health programs for children and improved access to private insurance through creation of a large purchasing pool, with reinsurance to keep premiums down. The four steps of the senator's plan are:

1. Cover all Children
  • expand the State Children's Health Insurance Program (SCHIP) to cover children in families with income up to at least 300 percent of the federal poverty level and allow higher-income families to buy in to the program on a sliding scale;
  • automatically enroll eligible, uninsured children in SCHIP or Medicaid through hospitals, schools, and programs such as reduced price school lunches, WIC, or Head Start; and
  • extend SCHIP coverage to at least age 21 to cover more young adults.
2. Access for Adults
  • create a purchasing pool (similar to the Federal Employees Health Benefits Program) in which all residents and small businesses can purchase insurance, with government subsidies;
  • allow individuals ages 55 to 64 to purchase Medicare coverage, with a premium subsidy for lower-income people;
  • prohibit employers and insurers from collecting or using genetic information in hiring, coverage, or premium contribution decisions; and
  • expand Medicaid eligibility to some low-income parents.
3. Reinsurance for Catastrophic Cases
  • establish a federal reinsurance pool that reimburses employers, insurers, or associations 75 percent of "catastrophic" costs exceeding $50,000 for an individual.
4. Encourage Prevention and Modernization
  • promote preventive care for children by eliminating copayments for physical exams, vaccines, vision and hearing tests, and preventive dental exams;
  • establish chronic disease treatment programs in Medicare and other federal programs to manage care;
  • establish a comparative effectiveness panel to evaluate treatments and establish best practices for chronic disease management;
  • promote uniform billing and claims, and invest substantially in electronic health record and other IT systems;
  • allow the federal government to negotiate prescription drug prices in Medicare Part D; and
  • invest to meet the health workforce needs (e.g., expand nurse training, public health workforce).
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Senator McCain's Market-Based Plan
Senator McCain would use the tax system to encourage the purchase of private insurance and promote competition, innovation, and personal responsibility. Specifically, he proposes to:
  • offer refundable tax credits of $2,500 and $5,000 to low-income individuals and families, respectively, for the purchase of private health insurance, allowing those with policies that cost less than the full credit to deposit the remainder in expanded health savings accounts;
  • require health care providers and pharmaceutical companies to make their prices publicly available;
  • publicize information on treatment options, medical outcomes, quality of care, and costs;
  • promote lower-cost generic medications and biotechnology, and safe reimportation of prescription drugs;
  • promote chronic disease management;
  • promote retail health clinics and other innovative delivery systems, and support telemedicine and clinics in underserved areas;
  • develop national markets by allowing residents to purchase health insurance in any state, and permitting health care providers to practice nationwide;
  • use tort reform to eliminate "frivolous" medical malpractice lawsuits and "excessive" damage awards, and to end lawsuits for doctors who follow clinical guidelines and adhere to patient safety protocols;
  • end Medicare reimbursement related to preventable medical errors or mismanagement, but allow payments for diagnosis, prevention, and care coordination;
  • give states greater flexibility in running their Medicaid programs (e.g., payment mechanisms, use of private insurance) and licensing medical providers;
  • require states to develop "risk adjustment" bonuses for high-cost and low-income families; and
  • promote personal responsibility through public health initiatives to curb obesity, diabetes, and smoking.

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