While the next presidential election is still almost 18 months away, many candidates have begun to discuss how they would reform the nation's health care system and address the issue of the nation's 47 million uninsured. States in Action will examine the reform proposals put forth by the candidates as they develop over the coming year. We expect some of the proposals to be based on existing state initiatives. Any federal plan, if enacted, would have an enormous impact on states.
The three Democratic front-runners—Hillary Clinton, John Edwards, and Barack Obama—as well as Republican Mitt Romney, have listed health care reform as one of their major policy areas. At this time, with Clinton, Edwards, and Obama having released detailed policy proposals, some similar themes and goals have emerged across their campaigns: stabilizing and expanding Medicaid and SCHIP, improving and expanding use of health information technology, increasing quality improvement and patient safety efforts, and promoting universal coverage.
In this issue, we highlight John Edwards's health care reform plan, as his was the first to be developed and released. His proposal calls for the following:
- a "play or pay" model for businesses, based on "health markets." These health markets would be nonprofit purchasing pools administered by one or a group of states to provide lower-cost private coverage to individuals who do not have access to employer-sponsored insurance or public coverage. Businesses would be able to purchase affordable coverage for their workers through these health markets.
- tax credits that low-income individuals can use to purchase health insurance;
- expansion of Medicaid and SCHIP to serve all adults with income below 100 percent of the FPL and all children and parents below 250 percent of the FPL;
- insurance reforms that would eliminate discrimination based on preexisting conditions, medical history, age, job, or other characteristics;
- securing the safety net by supporting public hospitals, clinics, and community health centers; and
- an individual mandate, once affordable options for all Americans are in place.
In addition to the coverage components of his plan, Edwards calls for a number of reforms and initiatives to improve quality of care, including the following:
- promoting evidence-based medicine;
- developing partnerships among academic medical centers, Medicare, and other federal agencies;
- implementing pay-for-performance measures through Medicare and the health markets by paying higher rates to plans and providers that provide the best care, offering lower premiums to consumers who chose those plans and providers, and penalizing plans that fail to meet quality-based goals; and
- supporting public–private collaborations to reduce medical errors and improve internal communications.
Finally, the Edwards plan includes wellness programs to motivate individuals to seek preventive care by rewarding them with lower premiums for enrolling in healthy living programs, supporting walking and biking trails, and physical education programs for children. Also on his agenda are disease and care management programs, which would be built in to the products created by health markets, support for use of information technology, and reduction of health disparities.
