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.
BARACK
OBAMA
AND
JOE
BIDEN'S
PLAN
FOR A HEALTHY AMERICA: LOWERING HEALTH CARE COSTS AND ENSURING AFFORDABLE, HIGHQUALITY HEALTH CARE FOR ALL
The U.S. spends over $2 trillion on medical care every year, and offers the best medical technology in the world.1 Americans have their choice of top doctors and hospitals, and our national investment in scientific research has paid off handsomely. Diseases that were once life-threatening are now curable; conditions that once devastated are now treatable. Yet, the benefits of the American health care system come at a price that an increasing number of individuals and families, employers and employees, and public and private providers cannot afford.
Millions of Americans are uninsured or underinsured because of rising medical costs. Nearly 46 million Americans2.including over 8 million children3.lack health insurance. Eighty percent of the uninsured are in working families.4 Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing health care costs are making it increasingly difficult for employers, particularly small businesses, to provide health insurance to their employees.
TO LOWER HEALTH CARE COSTS AND ENSURE AFFORDABLE, ACCESSIBLE HEALTH COVERAGE FOR ALL
Health
care
costs
are
skyrocketing.
Health
insurance
premiums
have
risen 4 times faster than wages in the past 6
doubled in the last 8 years, rising 3.7 times faster than wages in the past 8
years,
and
increasing
co-pays
and
deductibles
threaten
access
to
care.5
care.1
Many
insurance
plans
cover
only
a
limited
number
of
doctors'
visits
or
hospital
days,
exposing
families
to
unlimited
financial
liability.
Nearly 11 million insured spent more than a quarter of their salary on health care last year.6 And over
Over
half
of
all
personal
bankruptcies
today
are
caused
by
medical
bills.7
bills.2
Lack
of
affordable
health
care
is
compounded
by
serious
flaws
in
our
health
care
delivery
system.
About
100,000
Americans
die
from
medical
errors
in
hospitals
every
year.8 Prescription drug errors alone cost the nation more than $100 billion every year.9
year.3
One-quarter
of
all
medical
spending
goes
to
administrative
and
overhead
costs
costs,
and
reliance
on
antiquated
paper-based
record
and
information
systems
needlessly
increases
these
costs.10
costs.4
Tens of millions of Americans are uninsured because of rising costs. Over 45 million Americans5-- including over 8 million children6--lack health insurance. Eighty percent of the uninsured are in working families.7 Even those with health coverage are struggling to cope with soaring medical costs. Skyrocketing health care costs are making it increasingly difficult for employers, particularly small businesses, to provide health insurance to their employees.
Underinvestment
in
prevention
and
public
health.
Too
many
Americans
go
without
high-value
preventive
services,
such
as
cancer
screening
and
immunizations
to
protect
against
flu
or
pneumonia.
Providers are not adequately reimbursed for helping patients manage chronic illnesses like diabetes or asthma.11 Similarly, community-based prevention efforts, which have helped to drive down rates of smoking and lead poisoning, for example, are under-utilized despite their effectiveness.
The
nation
faces
epidemics
of
obesity
and
chronic
diseases
as
well
as
new
threats
of
pandemic
flu
and
bioterrorism.
Yet
despite
all
of
this
less
than
4
cents
of
every
health
care
dollar
is
spent
on
prevention
and
public
health.12
health.8
Our
health
care
system
has
become
a
disease
care
system,
and
the
time
for
change
is
well
overdue.
BARACK OBAMA AND JOE BIDEN'S PLAN FOR A HEALTHY AMERICA
Barack Obama and Joe Biden believe when it comes to health care America can and must do better. In the absence of national leadership, states have been leading the way with health care reforms that lower costs and provide coverage for all. Barack Obama and Joe Biden have a three part plan to build upon the strengths of the U.S. health care system, including innovative state efforts, and address its glaring weaknesses, such as affordability. Through partnerships among federal and state governments, employers, providers and individuals, the Obama-Biden plan will save a typical American family up to $2,500 every year on medical expenditures by:
(1) Providing affordable, comprehensive and portable health coverage for every American;
(2) Modernizing the U.S. health care system to contain spiraling health care costs and improve the quality of patient care; and
(3) Promoting prevention and strengthening public health, to prevent disease and protect against natural and man-made disasters.
Under the Obama-Biden plan, the typical family will save up to $2,500 every year through:
.. Health IT investment, which will reduce unnecessary spending in the system that results from preventable errors and inefficient paper billing systems;
.. Improving prevention and management of chronic conditions;
.. Increasing insurance industry competition and reducing underwriting costs and profits, which will reduce insurance overhead;
.. Providing reinsurance for catastrophic coverage, which will reduce insurance premiums; and
.. Making health insurance universal, which will reduce spending on uncompensated care
QUALITY, AFFORDABLE & PORTABLE HEALTH COVERAGE FOR ALL
Barack Obama and Joe Biden believe that every American has the right to affordable, comprehensive and portable health coverage. Currently there are nearly 46 million Americans lacking health insurance, and millions more are at risk of losing their coverage due to rising costs.13 Rising costs are also a burden on employers, particularly small businesses, which are increasingly unable to provide health insurance coverage for their employees and remain competitive. Three million fewer Americans receive health insurance coverage through their employers now compared to five years ago,14 and this trend shows no sign of slowing down. It is simply too expensive for individuals and families to buy insurance directly on the open market and impossible for many with pre-existing conditions.
The Obama-Biden plan will guarantee coverage for every American through partnerships among employers, private health plans, the federal government, and the states. The plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden plan, Americans will be able to maintain their current coverage if they choose to, and will see the quality of their health care improve and their costs go down. The Obama-Biden plan also addresses the large gaps in coverage that leave nearly 46 million Americans uninsured. Specifically, the Obama-Biden plan will: (1) establish a new public insurance program, available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees; (2) create a National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly; (3) require all employers to contribute towards health coverage for their employees or towards the cost of the public plan ; (4) mandate all children have health care coverage; (5) expand eligibility for the Medicaid and SCHIP programs; and (6) allow flexibility for state health reform plans.
(1) BARACK OBAMA AND JOE BIDEN'S PLAN TO COVER THE UNINSURED. Barack Obama and Joe Biden will make available a new national health plan which will give individuals the choice to buy affordable health coverage that is similar to the plan available to federal employees. The new public plan will be open to individuals without access to group coverage through their workplace or current public programs. It will also be available to people who are self-employed and small businesses that want to offer insurance to their employees.
The plan will have the following features:
.. Guaranteed eligibility. No American will be turned away FROM ANY INSURANCE PLAN because of illness or pre-existing conditions.
.. Comprehensive benefits. The benefit package will be similar to that offered through the Federal Employees Health Benefits Program (FEHBP), the program through which Members of Congress get their own health care. The new public plan will include coverage of all essential medical services, including preventive, maternity and mental health care. Coverage will include disease management programs, self management training and care coordination for appropriate individuals.
.. Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services.
.. Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need assistance will receive income-related federal subsidies to keep health insurance premiums affordable. They can use the subsidy to buy into the new public plan or purchase a private health care plan.
.. Simplifying paperwork and reining in health costs. The plan will simplify paperwork for providers and will increase savings to the system overall.
.. Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
.. Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage.
.. Quality and efficiency. Participating hospitals and providers that participate in the new public plan will be required to collect and report data to ensure that standards for health care quality, health information technology and administration are being met.
(2) NATIONAL HEALTH INSURANCE EXCHANGE. To provide Americans with additional options, the Obama- Biden plan will make available a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible. Through the Exchange, any American will have the opportunity to enroll in the new public plan or purchase an approved private plan, and income-based sliding scale subsidies will be provided for people and families who need it. Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.
(3) EMPLOYER CONTRIBUTION. Employers that do not offer meaningful coverage or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement.
(4) SUPPORT FOR SMALL BUSINESSES. Barack Obama and Joe Biden understand that the skyrocketing cost of healthcare poses a serious competitive threat to America's small businesses.15 Barack Obama and Joe Biden will create a Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees. To be eligible for the credit, small businesses will have to offer a quality health plan to all of their employees, and cover a meaningful share of the cost of employee health premiums. This new credit will provide a strong incentive to small businesses to offer high quality health care to their workers and help improve the competitiveness of America's small businesses.
(5) MANDATORY COVERAGE OF CHILDREN. Barack Obama and Joe Biden will require that all children have health care coverage. Barack Obama and Joe Biden will expand the number of options for young adults to get coverage by allowing young people up to age 25 to continue coverage through their parents' plans.
(6) EXPANSION OF MEDICAID AND SCHIP. Barack Obama and Joe Biden will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function.
(7) FLEXIBILITY FOR STATE PLANS. Due to federal inaction, some states have taken the lead in health care reform. These efforts are laudable and are helping to lead the way toward meaningful health care reform. The Obama-Biden plan is a national one that builds on these efforts, and it will not replace what states are doing. Indeed, states can continue to experiment, provided they meet the minimum standards of the national plan.
MODERNIZING THE U.S. HEALTH CARE SYSTEM TO LOWER COSTS & IMPROVE QUALITY
Health care spending is expected to double within the next decade.16 Though Americans spend almost twice as much per person as citizens of other industrialized countries,17 their health status is no better and by many measures actually worse. Americans die younger, and their newborns die more frequently than in other developed nations.18
OBAMA-BIDEN PLAN TO PROVIDE AFFORDABLE, ACCESSIBLE HEALTH CARE TO ALL
Barack Obama and Joe Biden's plan strengthens employer.based coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference. Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don't have health insurance, you will have a choice of new, affordable health insurance options.
LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM WORK FOR PEOPLE AND BUSINESSES -- NOT JUST INSURANCE COMPANIES
Inefficient
and
poor
quality
care
costs
the
nation
at
least
$50
to
$100
billion
every
year.19
year.9
Billions
more
are
wasted
on
administration
and
overhead
because
of
inefficiencies
in
the
health
care
system.20 America has the best health care technology in the world, but it is often not used well, and due to varying practices, it is often wasted.
system.10 And given current trends, this problem will only get worse as health care spending is expected to double within the next decade.11
A
growing
body
of
research
points
to
substantial
opportunities
to
improve
quality
while
reducing
the
costs
of
care.
Some researchers estimate that as much as 30 percent of health care is not contributing materially to patient outcomes.21
Health
care
systems
in
many
parts
of
the
country
deliver
high
quality
care
to
the
populations
they
serve
at
half
of the costs
the cost
of
other
equally
renowned
academic
medical
centers
in
other
parts
of
the
country.22 The key is to provide information, incentives,
country.12 The key is to provide information, incentives
and
support
to
help
physicians
and
others
work
together
to
improve
quality
of care
while
reducing
costs.
Barack
Obama
and
Joe
Biden
believe
we
must
dramatically
redesign
our
health
system
to
reduce
inefficiency
and
waste
and
improve
health
care
quality,
which
will
drive
down
costs
for
families
and
individuals.
The
Obama-Biden
plan
will
improve
efficiency
and
lower
costs
in
the
health
care
system
by:
(1)
adopting state-of-the-art health information technology systems; (2) ensuring that patients receive and providers deliver the best possible care, including prevention and chronic disease management services; (3) reforming our market structure to increase competition; and
offering
federal
reinsurance
to
employers
to
help
ensure
that
unexpected
or
catastrophic
illnesses
do
not
make
health
insurance
unaffordable
or
out
of
reach
for
businesses
and
their
employees (2) ensuring that patients receive and providers deliver the best possible care; (3) adopting state-of-the-art health information technology systems; and (4) reforming our market structure to increase competition.
(1) REDUCING COSTS OF CATASTROPHIC ILLNESSES FOR EMPLOYERS AND THEIR EMPLOYEES. Catastrophic health expenditures account for a high percentage of medical expenses for private insurers.23 In fact, the most recent data available reveals that the top five percent of people with the greatest health care expenses in the U.S. spent 49 percent of the overall health care dollar.24 For small businesses, having a single employee with catastrophic expenditures can make insurance unaffordable to all of the workers in the firm. The Obama-Biden plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums. Offsetting some of the catastrophic costs would make health care more affordable for employers, workers and their families.
(2) LOWERING COSTS BY ENSURING PATIENTS RECEIVE AND PROVIDERS DELIVER QUALITY CARE.
employees.
(1) INVEST IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims.13 Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients' privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.14
(2) IMPROVE ACCESS TO PREVENTION AND PROVEN DISEASE MANAGEMENT PROGRAMS.
Experts
agree
that
several
steps
should
be
taken
immediately
to
help
patients
get
the
care
they
need
and
to
help
providers
improve
medical
practice.
Barack
Obama
and
Joe
Biden
will
expand
and
support
these
and
other
efforts
to
lower
costs
and
improve
health
outcomes.
HELPING
HELP
PATIENTS
..
Support
disease
management
programs.
Over
seventy-five
percent
of
total
health
care
dollars
are
spent
on
patients
with
one
or
more
chronic
conditions,
such
as
diabetes,
heart
disease,
and
high
blood
pressure.25
pressure.15
Many
patients
with
chronic
diseases
benefit
greatly
from
disease
management
programs,
which
help
patients
manage
their
condition
and
get
the
care
they
need.26
need.16
Barack
Obama
and
Joe
Biden
will
require
that
plans
that
participate
in
the
new
public
plan,
Medicare
or
the
Federal
Employee
Health
Benefits
Program
(FEHBP)
utilize
proven
disease
management
programs.
This
will
improve
quality
of
care
and
lower
costs,
as
well.
..
Coordinate
and
integrate
care.
Rates
of
chronic
diseases
have
skyrocketed
in
the
last
2
decades.27
decades.17
Over
133
million
Americans
have
at
least
one
chronic
disease.28
disease.18
With
proper
care,
the
onset
and
progression
of
these
diseases
can
be
contained
for
many
years.
In
addition
to
the
needless
suffering
and
early
death
they
cause,
these
chronic
conditions
cost
a
staggering
$1.7
trillion
yearly.29 More than half of Americans with serious chronic conditions have 3 or more different physicians,30 leading to duplicate testing, conflicting treatment advice and prescription drugs that are contraindicated.
yearly.19
Barack
Obama
and
Joe
Biden
will
support
providers
to
put
in
place
care
management
programs
and
encourage
team
care
through
implementation
of
medical
home
type
models
that
will
improve
coordination
and
integration
of
care
of
those
with
chronic
conditions.
..
Require
full
transparency
about
regarding
quality
and
costs.
Health
care
quality
and
costs
can
vary
tremendously
among
hospitals
and
providers;
however,
patients
have
limited
access
to
this
information.31
information.20
Barack
Obama
and
Joe
Biden
will
require
hospitals
and
providers
to
collect
and
publicly
report
measures
of
health
care
costs
and
quality,
including
data
on
preventable
medical
errors,
nurse
staffing
ratios,
hospital-acquired
infections,
and
disparities
in
care,
care
and
costs.
Health
plans
will
be
required
to
disclose
the
percentage
of
premiums
that
actually
goes
to
paying
for
patient
care
as
opposed
to
administrative
costs.
ENSURING PROVIDERS DELIVER QUALITY CARE
.. Promoting
ENSURE PROVIDERS DELIVER QUALITY CARE
.. Promote
patient
safety.
Barack
Obama
and
Joe
Biden
will
require
providers
to
report
preventable
medical
errors,
and
support
hospital
and
physician
practice
improvement
to
prevent
future
occurrences.
.. Aligning
errors.
.. Align
incentives
for
excellence.
Both
public
and
private
insurers
tend
to
pay
providers
based
on
the
volume
of
services
provided,
rather
than
the
quality
or
effectiveness
of
care.32
care.21
Barack
Obama
and
Joe
Biden
will
accelerate
efforts
to
develop
and
disseminate
best
practices,
and
align
reimbursement
with
provision
of
high
quality
health
care.
Providers
who
see
patients
enrolled
in
the
new
public
plan,
the
National
Health
Insurance
Exchange,
Medicare
and
FEHB
will
be
rewarded
for
achieving
performance
thresholds
on
physician-validated
outcome
measures.
..
Comparative
effectiveness
reviews
and
research.
The U.S. provides some of the best health care and most sophisticated medical technologies in the world, but at a cost that is making the effort to expand access to care ever more difficult. In order to be able to provide health care coverage for all, we need to deliver the same quality of care at much lower cost. This is possible because there is considerable waste in our health care system and, at the same time, we are failing to provide highly effective services to patients who should have them.
One
of
the
keys
to
eliminating
waste
and
missed
opportunities
is
to
increase
our
investment
in
comparative
effectiveness
reviews
and
research.
Comparative effectiveness studies provide crucial information about which drugs, devices and procedures are the best diagnostic and treatment options for individual patients.
This
information
is
developed
by
reviewing
existing
literature,
analyzing
electronic
health
care
data,
and
conducting
simple,
real
world
studies
of
new
technologies.
Barack
Obama
and
Joe
Biden
will
establish
an
independent
institute
to
guide
reviews
and
research
on
comparative
effectiveness,
so
that
Americans
and
their
doctors
will
have
accurate
and
objective
information
to
make
the
best
decisions
for
their
health
and
well-being.
..
Tackling
Tackle
disparities
in
health
care.
Although
all
Americans
are
affected
by
problems
with
our
health
care
delivery
system,
an
overwhelming
body
of
evidence
demonstrates
that
certain
populations
are
significantly
more
likely
to
receive
lower
quality
health
care
than
others.
Minority Americans are less likely to receive early and timely health care for many conditions such as cancer, when such conditions could be treatable.33 Further, minority patients are less likely to receive recommended care that meets accepted standards of medical practice, which similarly has a negative impact on health outcomes.34 Other patient populations, including female35 and rural36 populations, experience disparities in health care as well.
Barack
Obama
and
Joe
Biden
will
tackle
the
root
causes
of
health
disparities
by
addressing
differences
in
access
to
health
coverage
and
promoting
prevention
and
public
health (see below),
health,
both
of
which
play
a
major
role
in
addressing
disparities.
They
will
also
challenge
the
medical
system
to
eliminate
inequities
in
health
care
by
requiring
hospitals
and
health
plans
to
collect,
analyze
and
report
health
care
quality
for
disparity
populations
and
holding
them
accountable
for
any
differences
found;
diversifying
the
workforce
to
ensure
culturally
effective
care;
implementing
and
funding
evidence-based
interventions,
such
as
patient
navigator
programs;
and
supporting
and
expanding
the
capacity
of
safetynet
safety-net
institutions,
which
provide
a
disproportionate
amount
of
care
for
underserved
populations
with
inadequate
funding
and
technical
resources.
..
Reforming
Reform
medical
malpractice
while
preserving
patient
rights.
Increasing
medical
malpractice
insurance
rates
are
making
it
harder
for
doctors
to
practice
medicine37 and raising the costs of health care for everyone38.
medicine22 and raising the costs of health care for everyone.23
Barack
Obama
and
Joe
Biden
will
strengthen
antitrust
laws
to
prevent
insurers
from
overcharging
physicians
for
their
malpractice
insurance.
Barack
Obama
and
Joe
Biden
will
also
promote
new
models
for
addressing
physician
errors
that
improve
patient
safety,
strengthen
the
doctorpatient
relationship,
and
reduce
the
need
for
malpractice
suits.
(3)
LOWERING COSTS THROUGH INVESTMENT IN ELECTRONIC HEALTH INFORMATION TECHNOLOGY SYSTEMS. Most medical records are still stored on paper, which makes them difficult to use to coordinate care, measure quality, or reduce medical errors. Processing paper claims also costs twice as much as processing electronic claims.39 Barack Obama and Joe Biden will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records. They will also phase in requirements for full implementation of health IT and commit the necessary federal resources to make it happen. Barack Obama and Joe Biden will ensure that these systems are developed in coordination with providers and frontline workers, including those in rural and underserved areas. Barack Obama and Joe Biden will ensure that patients' privacy is protected. A study by the Rand Corporation found that if most hospitals and doctors offices adopted electronic health records, up to $77 billion of savings would be realized each year through improvements such as reduced hospital stays, avoidance of duplicative and unnecessary testing, more appropriate drug utilization, and other efficiencies.40
(4) LOWERING COSTS BY INCREASING COMPETITION IN THE INSURANCE AND DRUG MARKETS.
LOWER COSTS BY TAKING ON ANTICOMPETITIVE ACTIONS IN THE DRUG AND INSURANCE COMPANIES.
It
is
not
right
that
Americans
families
are
paying
skyrocketing
premiums
while
drug
and
insurance
industries
are
enjoying
record
profits.
These
companies
benefit
most
from
the
status
quo,
quo
and
in
many
cases
are
the
greatest
obstacles
to
reform.
The
Obama-Biden
plan
will
tackle
needless
waste
and
spiraling
costs
by
increasing
competition
in
the
insurance
and
drug
markets.
..
Increasing
competition.
competition in the insurance industry.
The
insurance
business
today
is
dominated
by
a
small
group
of
large
companies
that
has
been
gobbling
up
their
rivals.
In
recent
years,
for-profit
companies
have
bought
up
not-for-profit
insurers
around
the
country.
Other not-for-profits found business so lucrative, they converted to for-profit companies.
There
have
been
over
400
health
care
mergers
in
the
last
10
years,
years
and
just
two
companies
dominate
a
full
third
of
the
national
market.41 The American Medical Association reports that 95% of insurance markets in the United States are highly concentrated42 and the number of insurers has fallen by just under 20% since 2000.43
market.24
These
changes
were
supposed
to
make
the
industry
more
efficient,
but
instead
premiums
have
skyrocketed,
increasing
over
87
percent
over
the
past
six
years.44
years.25
Over
the
same
time
period,
insurance
administrative
overhead
has
been
the
fastest-growing
component
of
health
spending.
The
2007
Commonwealth
Fund
Commission
on
a
High
Performance
Health
System
reported
that
between
2000
and
2005,
administrative
overhead
.
including
both
administrative
expenses
and
insurance
industry
profits
.
increased
12.0
percent
per
year,
3.4
percentage
points
faster
than
the
average
health
expenditure
growth
of
8.6
percent.45
percent.26
And
while
health
care
costs
continue
to
rise
for
families,
CEOs
of
these
insurance
companies
have
received
multi-million
dollar
bonuses.46
bonuses.27
Barack
Obama
and
Joe
Biden
will
prevent
companies
from
abusing
their
monopoly
power
through
unjustified
price
increases.
In
markets
where
the
insurance
business
is
not
competitive,
their
plan
will
force
insurers
to
pay
out
a
reasonable
share
of
their
premiums
for
patient
care
instead
of
keeping
exorbitant
amounts
for
profits
and
administration.
Barack
Obama
and
Joe
Biden's
new
National
Health
Insurance
Exchange
will
also
help
increase
competition
by
insurers.
..
Drug reimportation.
Prevent private insurance waste and abuse in Medicare. Medicare's private plan alternative, called Medicare Advantage, was established to increase competition and reduce costs. But independent reports show that on average the government pays 12 percent more than it costs to treat comparable beneficiaries through traditional Medicare.28 These excessive subsidies cost the government billions of dollars every year and create an incentive structure that has led to fraudulent abuses of seniors. Barack Obama and Joe Biden believe we need to eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare.
.. Allow consumers to import safe drugs from other countries.
The
second-fastest
growing
type
of
health
expenses
is
prescription
drugs.47
drugs.29
Pharmaceutical
companies
should
profit
when
their
research
and
development
results
in
a
groundbreaking
new
drug.
But
some
companies
are
exploiting
Americans
by
dramatically
overcharging
U.S.
consumers.
These
companies
are
selling
the
exact
same
drugs
in
Europe
and
Canada
but
charging
Americans
a
67
percent
premium.48
premium.30
Barack
Obama
and
Joe
Biden
will
allow
Americans
to
buy
their
medicines
from
other
developed
countries
if
the
drugs
are
safe
and
prices
are
lower
outside
the
U.S.
Increasing use of generics.
.. Prevent drug companies from blocking generic drugs from consumers.
Some
drug
manufacturers
are
explicitly
paying
generic
drug
makers
not
to
enter
the
market
so
they
can
preserve
their
monopolies
and
keep
charging
Americans
exorbitant
prices
for
brand
name
products.49
products.31
The
Obama-Biden
plan
will
work
to
ensure
that
market
power
does
not
lead
to
higher
prices
for
consumers.
Their
plan
will
work
to
increase
use
of
generic
drugs
in
the
new
public
plan,
Medicare,
Medicaid,
FEHBP
and
prohibit
large
drug
companies
from
keeping
generics
out
of
markets.
Lowering Medicare prescription drug benefit costs.
.. Allow Medicare to negotiate for cheaper drug prices.
The
2003
Medicare
Prescription
Drug
Improvement
and
Modernization
Act
bans
the
government
from
negotiating
down
the
prices
of
prescription
drugs,
even
though
the
Department
of
Veterans
Affairs'
negotiation
of
prescription
drug
prices
with
pharmaceutical
drug
companies
has
garnered
significant
savings
for
taxpayers.50
taxpayers.32
Barack
Obama
and
Joe
Biden
will
repeal
the
ban
on
direct
negotiation
with
drug
companies
and
use
the
resulting
savings,
which
could
be
as
high
as
$30
billion,51
billion,33
to
further
invest
in
improving
health
care
coverage
and
quality.
.. Preventing waste and abuse in Medicare. Medicare's private plan alternative, called Medicare Advantage, was established to increase competition and reduce costs. But independent reports show that on average the government pays 12 percent more than it costs to treat comparable beneficiaries through traditional Medicare.52 These excessive subsidies cost the government billions of dollars every year and create an incentive structure that has led to fraudulent abuses of seniors. Barack Obama and Joe Biden believe we need to eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare.
(4) REDUCE COSTS OF CATASTROPHIC ILLNESSES FOR EMPLOYERS AND THEIR EMPLOYEES. Catastrophic health expenditures account for a high percentage of medical expenses for private insurers.34 In fact, the most recent data available reveals that the top five percent of people with the greatest health care expenses in the U.S. account for 49 percent of the overall health care dollar.35 For small businesses, having a single employee with catastrophic expenditures can make insurance unaffordable to all of the workers in the firm. The Obama-Biden plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums. Offsetting some of the catastrophic costs would make health care more affordable for employers, workers and their families.
AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL
Barack Obama and Joe Biden will guarantee affordable, accessible health care coverage for all Americans. Currently, there are over 45 million Americans lacking health insurance, and millions more are at risk of losing their coverage due to rising costs.36 Rising costs are also a burden on employers, particularly small businesses, which are increasingly unable to provide health insurance coverage for their employees and remain competitive. Nearly two million fewer Americans receive health insurance coverage through their employers now compared to eight years ago,37 and this trend shows no sign of slowing down. It is simply too expensive for individuals and families to buy insurance directly on the open market and impossible for many with pre-existing conditions.
The Obama-Biden plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down. The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can't afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.
(1) GUARANTEED ELIGIBILITY. Obama and Biden will require insurance companies to cover pre-existing conditions so all Americans, regardless of their health status or history, can get comprehensive benefits at fair and stable premiums.
(2) NEW AFFORDABLE, ACCESSIBLE HEALTH INSURANCE OPTIONS. The Obama-Biden plan will create a National Health Insurance Exchange to help individuals purchase new affordable health care options if they are uninsured or want new health insurance. Through the Exchange, any American will have the opportunity to enroll in the new public plan or an approved private plan, and income-based sliding scale tax credits will be provided for people and families who need it. Insurers would have to issue every applicant a policy and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and meet the same standards for quality and efficiency. Insurers would be required to justify an above-average premium increase to the Exchange. The Exchange would evaluate plans and make the differences among the plans, including cost of services, transparent.
The Exchange will have the following features:
.. Comprehensive benefits. The benefit package will be similar to that offered through the Federal Employees Health Benefits Program (FEHBP), the program through which Members of Congress get their own health care. Plans will include coverage of all essential medical services, including preventive, maternity and mental health care.
.. Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services.
.. Simplified paperwork. The plan will simplify paperwork for providers and will increase savings to the system overall.
.. Easy enrollment. All Exchange health insurance plans will be simple to enroll in and provide ready access to coverage.
.. Portability and choice. Participants will be able to move from job to job without changing or jeopardizing their health care coverage.
.. Quality and efficiency. Participating hospitals and providers that participate in the new public plan will be required to collect and report data to ensure that standards for health care quality, health information technology and administration are being met.
(3) TAX CREDITS FOR FAMILIES AND SMALL BUSINESSES. Barack Obama and Joe Biden understand that too many families that do not qualify for public health programs like Medicaid and SCHIP have trouble finding affordable health insurance. They know from talking to small business owners across the nation that the skyrocketing cost of healthcare poses a serious competitive threat to America's small businesses. The Obama- Biden health care plan will provide tax credits to all individuals who need it for their premiums. They will also create a new Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to 50 percent on premiums paid by small businesses on behalf of their employees. To be eligible for the credit, small businesses will have to offer a quality health plan to all of their employees and cover a meaningful share of the cost of employee health premiums.
(4) EMPLOYER CONTRIBUTION. Large employers that do not offer meaningful coverage or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small businesses will be exempt from this requirement.
(5) REQUIRE COVERAGE OF CHILDREN. Barack Obama and Joe Biden will require that all children have health care coverage. Barack Obama and Joe Biden will expand the number of options for young adults to get coverage by allowing young people up to age 25 to continue coverage through their parents' plans.
(6) EXPANSION OF MEDICAID AND SCHIP. Barack Obama and Joe Biden will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function.
(7) FLEXIBILITY FOR STATE PLANS. Due to federal inaction, some states have taken the lead in health care reform. Under the Obama-Biden plan, states can continue to experiment, provided they meet the minimum standards of the national plan.
PROMOTING
PREVENTION
&
STRENGTHENING
PUBLIC
HEALTH
Covering
the
uninsured
and
modernizing
America's
health
care
system
are
urgent
priorities,
but
they
are
not
enough.
Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.
This
nation
is
facing
a
true
epidemic
of
chronic
disease.
An
increasing
number
of
Americans
are
suffering
and
dying
needlessly
from
diseases
such
as
obesity,
diabetes,
heart
disease,
asthma
and
HIV/AIDS,
all
of
which
can
be
delayed
in
onset
if
not
prevented
entirely.
One
in
3
Americans.133 million.have
Americans--133 million--have
a
chronic
condition,
and
children
are
increasingly
being
affected.53 The Centers for Disease Control and Prevention has reported that 1 in 3 children born in 2000 will develop diabetes in their lifetime.54 Five chronic diseases.heart
affected.38 Five chronic diseases--heart
disease,
cancer,
stroke,
chronic
obstructive
pulmonary
disease,
and
diabetes.cause over two-thirds of all deaths each year.55
diabetes--cause over two-thirds of all deaths each year.39
In
addition
to
the
tremendous
human
cost,
chronic
diseases
exact
a
tremendous
financial
toll
on
our
health
care
resources.
Care
for
patients
with
diabetes
costs
$130
billion
each
year
alone,
and
this
amount
is
growing.56
growing.40
Tackling
chronic
diseases
is
also
straining
our
public
health
departments
and
finances,
which
are
already
stretched
too
thin
carrying
out
traditional
public
health
functions,
which
include
ensuring
our
water
is
safe
to
drink,
the
air
is
safe
to
breathe,
and
our
food
is
safe
to
eat.
And these traditional public health functions have evolved to include disaster preparedness and response for both natural and man-made disasters.
Barack
Obama
and
Joe
Biden
believe
that
protecting
and
promoting
health
and
wellness
in
this
nation
is
a
shared
responsibility
among
individuals
and
families,
school
systems,
employers,
the
medical
and
public
health
workforce,
and
federal
and
state
and
local
governments.
Each
All parties
must
do
their
part,
as
well
as
collaborate
with
one
another,
to
create
the
conditions
and
opportunities
that
will
allow
and
encourage
Americans
to
adopt
healthy
lifestyles.
(1)
EMPLOYERS.
Reduced
workforce
productivity
from
illness
and
disability
represents
an
additional
drain
on
business.
To
address
employee
health,
an
increasing
number
of
employers
are
offering
worksite
health
promotion
programs,
onsite
clinical
preventive
services
such
as
flu
vaccinations,
nutritious
foods
in
their
cafeterias
and
vending
machines,
and
exercise
facilities.
Equally
important,
many
employers
choose
insurance
plans
that
cover
preventive
services
for
their
employees.
Barack
Obama
and
Joe
Biden
believe
that
worksite
interventions
hold
tremendous
potential
to
influence
health
and
they
will
expand
and
reward
these
efforts.
(2)
SCHOOL
SYSTEMS.
A generation ago, nearly half of all school-aged children walked or biked to school.57 Today, nearly 9 out of 10 children are driven to school.58 And once there, children are not very physically active.only 8 percent of elementary schools require daily physical education.59 Childhood obesity is nearly epidemic,60 particularly among minority populations,61
Childhood obesity is nearly epidemic,41 particularly among minority populations,42
and
school
systems
can
play
an
important
role
in
tackling
this
issue.
For
example,
only
about
a
quarter
of
schools
adhere
to
nutritional
standards
for
fat
content
in
school
lunches.62
lunches.43
Barack
Obama
and
Joe
Biden
will
work
with
schools
to
create
more
healthful
environments
for
children,
including
assistance
with
contract
policy
development
for
local
vendors,
grant
support
for
schoolbased
school-based
health
screening
programs
and
clinical
services,
increased
financial
support
for
physical
education,
and
educational
programs
for
students.
(3)
WORKFORCE.
Primary
care
providers
and
public
health
practitioners
have
and
will
continue
to
lead
efforts
to
protect
and
promote
the
nation's
health.
Yet,
the
numbers
of
both
are
dwindling,63
dwindling,44
and
the
existing
workforce
is
further
challenged
by
inadequate
training
about
for
new
health
threats
such
as
bioterrorism
and
avian
flu,
antiquated
funding
and
reimbursement
mechanisms,
and
limited
access
to
real-time
information
and
technical
support.
Barack
Obama
and
Joe
Biden
will
expand
funding.including
funding--including
loan
repayment,
adequate
reimbursement,
grants
for
training
curricula,
and
infrastructure
support
to
improve
working
conditions.
conditions--
to
ensure
a
strong
workforce
that
will
champion
prevention
and
public
health
activities.
(4)
INDIVIDUALS
AND
FAMILIES.
The way Americans live, eat, work and play have real implications for their health and wellness. Reports show that over half of U.S. adults do not engage in physical activity at levels consistent with public health recommendations.64 And the Surgeon General's report has shown that smoking kills an estimated 440,000 Americans each year and costs $75 billion in direct medical costs.65
Preventive
care
only
works
if
Americans
take
personal
responsibility
for
their
health
and
make
the
right
decisions
in
their
own
lives
.
if
they
eat
the
right
foods,
stay
active,
and
stop
smoking.
Individuals and families must have access to essential clinical preventive services such as cancer screenings and smoking cessation programs, and the Obama-Biden health plan will require coverage of such vegetables,
vegetables;
restricted
advertising
for
tobacco
and
alcohol
to
children;
and
wellness
and
educational
campaigns.
In
addition,
Barack
Obama
and
Joe
Biden
will
increase
funding
to
expand
community
based
preventive
interventions
to
help
Americans
make
better
choices
to
improve
their
health.
(5)
FEDERAL,
STATE,
AND
LOCAL
GOVERNMENTS.
The
federal
government
and
state
and
local
governments
play
critical
roles
across
the
full
range
of
disease
prevention
and
health
promotion
activities.
First,
working
together,
governments
at
all
levels
should
lead
the
effort
to
develop
a
national
and
regional
strategy
for
public
health,
health
and
align
funding
mechanisms
to
support
its
implementation.
Second,
the
field
of
public
health
would
benefit
from
greater
research
to
optimize
organization
of
the
3,000
health
departments
in
this
nation,66
nation,45
collaborative
arrangements
between
levels
of
government
and
its
private
partners,
performance
and
accountability
indicators,
integrated
and
interoperable
communication
networks,
and
disaster
preparedness
and
response.
Third,
the
government
must
invest
in
workforce
recruitment
as
well
as
modernizing
our
physical
structures,
particularly
our
public
health
laboratories.
And
finally,
the
government
must
examine
its
own
policies,
including
agricultural,
educational,
environmental
and
health
policies,
to
assess
and
improve
their
effect
on
public
health
in
this
nation.
Barack
Obama
and
Joe
Biden
will
prioritize
all
of
these
activities,
to
ensure
a
21st
century
public
health
system
and
healthy
America.