Grading Rubric for Presidential Candidates on Universal Health Care
1. Health care coverage should be universal: Only by making coverage universal for all people living in the United States will the sizeable gap in coverage that persists be closed.
| A | B | C | D | F | Truant |
| Goal is 100% coverage of | Goal is to cover all U.S. citizens, but excludes undocumented persons and permanent residents or imposes a waiting time for them. Plan's ambition is to achieve its | Goal is to cover more than half of the currently uninsured, but not all. Plan's ambition is to achieve its | Goal is to cover more, but less than half of | Goal is to cover more of the uninsured, but does not specify how many and the likelihood is that less than a third of the currently uninsured would gain coverage or that the plan would not achieve its goals within 4 years of implementation. | No plan is offered. |
Criteria for review: No one should be excluded from insurance coverage based on poor health status, a pre-existing condition or chronic illness. There should be few or no administrative barriers to obtaining or renewing insurance. Health insurance coverage should be guaranteed to all persons in the United States.
2. Health care coverage should be continuous: Frequently health coverage is interrupted due to a variety of factors. This sort of health coverage insecurity is not compatible with true universal quality health coverage.
| A | B | C | D | F | Truant |
| Goal is to provide uninterrupted coverage despite changes in employment, location or health status. Barriers including re-enrollment requirements are eliminated. | Goal is to provide continuous coverage. However, paperwork may be required for changes in location or employment. There are no standing re-enrollment requirements. | Goal is to facilitate transitions but assumes short interruptions | Goal is to facilitate transitions, | Health plan | No plan is offered. |
Criteria for review: Everyone should have access to a primary care provider and medical home throughout their lifespan. Consistent coverage must be transportable across employment, unemployment or geographic relocation.
3. Health care coverage should be affordable to individuals and families: Cost is one of the most important barriers to people accessing health care. A strong universal coverage plan should ensure that costs are minimized and reasonable for all Americans.
| Honors | Pass | Fail | Truant |
| The plan will cost less than 5% of annual household income. | The plan will cost between 5%-10% of annual household income. | The plan would put families at risk for incurring health care costs greater than 10% of annual household income. | No plan is offered. |
Criteria for review: Every American should have access to an insurance premium that they can afford. This means that financial assistance will be necessary for lower-income individuals and families. Co-pays and deductibles present a barrier to care for low-income people. They tend to discourage people from obtaining necessary medical care. We oppose co-payments that impose significant financial barriers to care.*
4. The health insurance strategy should be affordable and sustainable for society: Major reform proposals will need mechanisms to control inflation and encourage use of efficacious, cost-effective services.
| A | B | C | D | F | Truant |
| Payments to providers and suppliers, and patients' cost- sharing will be linked to the cost- | Only two of the stakeholders (providers, suppliers or patients) have reimbursement or cost-sharing linked to cost- effectiveness and quality of services. System integration is sufficient to impact, but not fully control, quality and cost. Total administrative costs are less than 10%. | Only two of the stakeholders (providers, suppliers or patients) have reimbursement or cost-sharing linked to cost- | Only one of the stakeholders (providers, suppliers or patients) have reimbursement or cost-sharing linked to cost- | No stakeholders have reimbursement | No plan is offered. |
Criteria for review: Physicians and other health care providers will play a vital role in health care cost-containment through a renewed emphasis on the stewardship of clinical resources. The cost of health care should be distributed equitably across the entire population. Any reform should minimize administrative cost, and simplify enrollment, underwriting and billing procedures. The government should be able to negotiate prices with pharmaceutical and medical device companies to ensure quality, low-cost medications for all.**
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable:
| A | B | C | D | F | Truant |
| The plan provides coverage for comprehensive care including preventative | The plan provides coverage for comprehensive care including preventative | The benefits package is similar to Medicare. It includes mechanisms | The benefits package is similar to Medicare, but has fewer benefits (i.e. does not provide drug coverage). | The plan provides coverage only for catastrophic medical expenses. The plan does not provide for preventative and screening services, address system evaluation, or include reform for the medical liability system to enhance patient safety. | No plan is offered. |
Criteria for review: Basic benefit packages must include preventive and screening services, prescription drugs, dental care, and mental health care as well as outpatient and hospital services. Payment strategies should promote evidence-based medical care. Reforms such as malpractice reform should promote patient safety and enhance patient care.
*This rubric does not address the issue of paying for long-term care.
**This rubric does not take into account potential cost-savings from the implementation health information technology as there is no current evidence of the magnitude, if any, of the cost-savings.
1/22/08