Barack Obama
Campaign website: http://www.barackobama.com/issues/healthcare/
Institute of Medicine health care reform principles necessary for the foundation of a just health care system (IOM 2004, http://www.iom.edu/CMS/3809/4660/17632.aspx):
1. Health care coverage should be universal.
Grade C: The Obama plan includes an individual mandate for children, but not adults. This plan includes the creation of a new national health plan with guaranteed eligibility open to individuals without access through their employer, the self-employed and small businesses. Additionally, a National Health Insurance Exchange will be created to help individuals who wish to purchase a private insurance plan. Private plans in the Exchange must offer coverage to anyone who applies and pays a fair premium, regardless of any preexisting medical condition. Employers must offer health insurance to employees, contribute to employee purchased plans or pay a payroll tax. Medicaid and SCHIP will be expanded. The Obama plan gets a C because it will cover all American children, but not adults, and it does not specify if it will also cover undocumented persons and permanent residents.
2. Health care coverage should be continuous.
Grade B: Policies purchased through the new national health plan and the National Health Insurance Exchange will be portable. The plan gets a B rather than an A because it doesn't describe how individuals insured through their employer would be continuously insured if they lost or changed their job.
3. Health care coverage should be affordable to individuals and families.
Grade P: The Obama plan will offer income-related federal subsidies to individuals and families to purchase health insurance. Federal subsidies will partially reimburse employers for catastrophic health care costs if the employers guaranteed that premium savings would be used to reduce employee premiums. Insurance plans in the Exchange must charge a "fair and stable" premium that is not rated on the basis of health status and justify above-average premium increases. Preventive services will be provided with minimal co-pays or deductibles. The plan receives a passing grade rather than an honors grade because it lacks the details on the size of the subsidies or the definition of "affordable."
4. The health insurance strategy should be affordable and sustainable for society.
Grade C: The Obama plan supports disease management programs, adoption of health information technology, allows drug re-importation and increases use of generic drugs. Health insurance companies will have to disclose what percent of premiums is spent on health care versus administrative costs. Employer health plans will be eligible for reimbursement of a portion of catastrophic costs. This plan will enable Medicare to negotiate for the price of drugs with pharmaceutical companies and end subsidies to Medicare Advantage plans. Reimbursement from all public plans and private plans in the Exchange will be aligned with performance on physician-validated outcome measures. The plan received a C because the cost-cutting mechanisms are unlikely to reduce overall administrative costs to less than 10%, the system is loosely integrated and there is no provision to link patients' cost-sharing with the cost-effectiveness of the services they choose.
Grade A: The Obama plan requires a comprehensive benefit plan including preventive services, mental health care and disease management. "Medical home" type models would be encouraged. Hospitals and providers must publicly report measures of health care costs and quality. The plan will align reimbursement with achieving performance thresholds on physician-validated outcome measures. The Obama plan establishes an independent institute to guide research on comparative effectiveness. This plan will strengthen antitrust laws to prevent insurers from overcharging physicians for malpractice insurance. The plan will promote new models for addressing physician errors to improve patient safety. The plan received an A because if offered a fairly comprehensive range of services covered through the purchasing pool and promised to look at new models for medical malpractice that would promote patient safety.
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