Table of Contents Summary of Senator John McCain s Health Care Platform.... 3 Summary of Senator Barack Obama s Health Care Platform.5 Comparison of 2008 Presidential Candidate Health Care Platforms....8 Comparison of Presidential Health Care Platforms vs. APhA Advocacy Agenda....10 Additional Resources..... 11 2
Summary of Senator John McCain s Health Care Platform Senator John McCain s health care agenda focuses on three goals: 1. Paying only for quality medical care; 2. Having insurance choices that are diverse and responsive to individual needs; and 3. Restoring a sense of personal responsibility. Paying for Quality Care Promote competition throughout the health care system - between providers and among alternative treatments. Make public information on treatment options and require transparency by providers regarding medical outcomes, quality of care, costs, and prices. Facilitate the development of national standards for measuring and recording treatments and outcomes. Reform the payment systems in Medicare to compensate providers for diagnosis, prevention, and care coordination. Prohibit Medicare from paying for preventable medical errors or mismanagement. Dedicate federal research on the basis of sound science to focus on care and cure of chronic disease. Give states greater flexibility, and encourage them to experiment with: o Alternative forms of access; o Risk-adjusted payments per episode covered under Medicaid; o Use of private insurance in Medicaid; o Alternative insurance policies and insurance providers; and o Different licensing schemes for medical providers. Build national markets by permitting providers to practice nationwide. Promote rapid deployment of 21 st century information systems. Support innovative delivery systems, such as clinic outlets and other ways that provide greater market flexibility in permitting appropriate roles for nurse practitioners, nurses, and doctors Where cost-effective, employ telemedicine, and community and mental health clinics in areas where services and providers are limited. Foster the development of routes for safe and less-expensive generic versions of drugs and biologic pharmaceuticals. Develop safety protocols that permit prescription drug re-importation. Pass tort reform to help address increasing insurance premiums. Provide a safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols. Protect the health care consumer through vigorous enforcement of federal protections against collusion, unfair business actions, and deceptive consumer practices. Encourage and expand Heath Savings Accounts. Provide veterans with a choice in health care providers and locations for care. 3
Insurance Reform Reform the tax code to eliminate incentives towards employer-sponsored health insurance, instead providing all individuals with a $2,500 tax credit ($5,000 for families) to purchase insurance. Individuals owning multi-year policies that cost less than the full credit can deposit the remainder in expanded health savings accounts. Enable individuals to purchase health insurance nation-wide, exempt from state laws. Allow for insurance to move from job to home, job to job, and provide multi-year coverage. Require any state receiving Medicaid to develop a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds. Allow individuals to purchase insurance through any organization or association that they choose: employers, individual purchasers, churches, professional associations, and others. Personal Responsibility Make patients the center of care and give them a larger role in both prevention and care, putting more decisions and responsibility in their hands. Require individuals to do more to prevent chronic diseases when possible, and to adhere to treatment after being diagnosed with an illness. Teach children about health, nutrition, and exercise. Launch public health initiatives to stem the growing epidemic of obesity and diabetes, and to deter smoking. 4
Summary of Senator Barack Obama s Health Care Platform Senator Barack Obama s health care agenda focuses on: 1. Providing affordable, comprehensive, and portable health coverage for every American; 2. Modernizing the health care system to contain costs and improve the quality of care; and 3. Promoting prevention and strengthening public health to prevent disease and protect against natural and man-made disasters. Coverage for All 1. Make available a new national health plan which would give individuals the option to buy health coverage similar to the Federal Employees Health Benefits Program (FEHBP). This program would be available to uninsured individuals, self-employed individuals, and small businesses. The plan would include the following features: Guaranteed eligibility: no one would be denied coverage because of illness or preexisting conditions; Benefits similar to the FEHBP, including preventive, maternity, and mental health care, as well as disease management, self management training, and care coordination; Low premiums, co-pays, and deductibles for preventive services; Subsidies for low-income individuals and families who do not qualify for Medicaid or State Children s Health Insurance Program (SCHIP); Simplify paperwork for providers; Simplify enrollment for individuals; Ensure portability when moving jobs; and Collection and reporting of data to ensure that standards for quality, health IT, and administration are met. 2. Create a National Health Insurance Exchange to help individuals and businesses purchase private insurance plans. All Americans would be able to enroll through the Exchange in an approved private plan or the new public plan. Income-based sliding scale subsidies would be available. All plans would require that their benefits be at least as generous as the new public plan and meet the same quality and efficiency standards. 3. Employers that do not offer a certain level of coverage or make a specific contribution to health care coverage for their employees would be required to contribute a percentage of payroll toward the cost of the national plan. 4. All children would be covered and individuals up to the age of 25 may continue coverage through parents plans. 5. Expanded eligibility for Medicaid and SCHIP. 6. States would have flexibility to continue to experiment with health care coverage, provided the same minimum standards of the national plan are met. Modernizing the Health care System 1. Reduce costs of catastrophic illnesses for employers and employees through reimbursing employer health plans for a portion of the catastrophic costs incurred above a threshold if they guarantee such savings would be used to reduce the cost of the employees premiums. 2. Ensure quality care is delivered by providers and received by patients by: Supporting disease management programs and requiring plans in the new public plan, Medicare, and FEHBP to utilize proven disease management programs. 5
Supporting providers with care management programs and team care through implementation of medical home models which improve coordination and integration of care for those with chronic conditions. Requiring hospitals and providers to collect and publicly report health care quality and cost measures, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care and costs. Plans would be required to disclose the percentage of premiums that goes toward patient care as opposed to administrative costs. Accelerating efforts to develop and disseminate best practices, and aligning reimbursement with the provision of quality care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare, and FEHBP would be rewarded for achieving performance thresholds. Establishing an independent institute to guide reviews and research on comparative effectiveness. Addressing the root causes of health disparities, including access to health coverage and promoting prevention. Challenge the medical system to eliminate inequities by requiring hospitals and health plans to collect, analyze, and report on health care quality for disparate populations; diversify the workforce; implement and fund evidence-based interventions; and support and expand safety net institutions. Reforming medical malpractice by strengthening antitrust laws to prevent insurers from overcharging physicians for malpractice insurance. Promoting new models to address physician errors that improve patient safety, strengthen doctor-patient relations, and reduce need for malpractice suits. 3. Invest $10 billion a year over the next five years to move the health care system to broad adoption of standards-based electronic health information systems, including electronic health records. 4. Increase competition in the insurance and drug markets by: Requiring insurers to pay out a reasonable share of their premiums for patient care instead of keeping for profits and administration. Permitting prescription drug re-importation from developed countries if drugs are safe and prices are lower outside of the U.S. Increasing the use of generics and prohibiting brand companies from keeping generics off of the market. Authorizing Medicare to negotiate drug prices. Eliminating subsidies to Medicare Advantage plans. Prevention and Public Health 1. Expand and reward employer efforts related to worksite interventions such as health promotion programs, flu vaccinations, nutritious foods in cafeterias, and exercise facilities. 2. Work with schools to create healthier environments for children, including school-based health screening programs and clinical services, and increased financial support for physical education. 3. Expand work force funding, including loan repayment, reimbursement, grants for training curricula, and infrastructure support for working conditions. 6
4. Require coverage of clinical preventive services such as cancer screenings and smoking cessation programs in all federally supported programs. Increase funding to expand community-based preventive interventions. 5. Develop a government-led, national and regional strategy for public health and invest in greater public health research, disaster preparedness and response, and workforce recruitment. 7
Comparison of 2008 Presidential Candidate Health Care Platforms Issue Senator McCain Senator Obama Health Care Reform Promotes competition throughout health care system Reforms Medicare payment systems to pay for diagnosis, prevention, and care coordination Dedicates Federal research to greater focus on care and cure of chronic diseases Allows States flexibility to experiment with alternative care and payment models Supports innovative delivery systems such as clinics in retail outlets Encourages and expand Health Savings Accounts Provides veterans with greater choice in health care providers Encourages patients to have a greater role in prevention and care, putting more decisions and responsibility in their hands Provides choice of two new programs: 1. Similar to FEHBP that would be available to uninsured individuals, self-employed individuals, and small businesses 2. New public plan Expands Medicaid and SCHIP eligibility Focuses on prevention and strengthening public health services Creates the National Health Insurance Exchange to help individuals and businesses purchase private insurance plans Requires coverage for all children Allows States flexibility to experiment with health care coverage, provided the same minimum standards of the nation plan are met Reimburses employers for a portion of catastrophic costs incurred for employees above a certain threshold Biosimilars and Generic Drugs Supports use of generics and regulatory pathway for biosimilars Supports use of generics and regulatory pathway for biosimilars Heath Care Quality Advocates for a coordinated care system that requires a single bill for all procedures in place of the current, fragmented structure Focuses on management of chronic disease and payment that rewards quality Prohibits Medicare from reimbursing preventable medical errors Provides public information on treatment options and requires transparency by providers regarding outcomes, quality of care, costs, and prices Emphasizes prevention and coordinated care of chronic diseases Requires health care plans participating in existing and new public health care programs to utilize proven disease management programs Requires hospitals and providers to collect and publicly report health care quality and cost measures Accelerates efforts to develop and disseminate best practices and aligns reimbursement with provision of quality care 8
Facilitates development of national standards for measuring and recording treatments and outcomes Addresses health care disparities Health Information Technology Promotes the prompt development of health IT systems Where cost effective, employs telemedicine Invests $10 billion a year over next five years to transition to standards-based electronic health information system Importation of Prescription Medications Supports prescription drug importation, with safety protocols to be developed Supports prescription drug importation from developed countries if they are proven safe and cost less outside the U.S. Medicare Part D Supports direct negotiation of Medicare prescription drugs Medical Liability Reform Supports tort reform to eliminate frivolous lawsuits and excessive damage awards Provides safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols Reforms medical malpractice by strengthening antitrust laws to prevent insurers from overcharging physicians for malpractice insurance Promotes new models for addressing physician errors that improve patient safety, strengthen doctor-patient relations and reduces need for malpractice suits 9
Comparison of Presidential Health Care Platforms vs. Key Elements of APhA s Advocacy Agenda Issue Senator McCain Senator Obama Behind-the-Counter (BTC) Availability of Certain Medications Medication Therapy Management Advocates for a coordinated care system that requires a single bill for all procedures in place of the current, fragmented structure Focuses on management of chronic disease and payment that rewards quality Emphasizes prevention and coordinated care of chronic diseases Would require health care plans participating in existing and new public health care programs to utilize proven disease management programs Recognition of Pharmacists Services Under Medicare Part B Illegal Prescription Drug Importation & Internet Access to Prescription Drugs Supports prescription drug importation, with safety protocols to be developed Supports prescription drug importation from developed countries if they are proven safe and cost less outside the U.S. Medicare Part D (Remark: Senator McCain voted against creating the Medicare Part D program) Supports direct negotiation of Medicare prescription drug prices 10
Additional Resources For more information on the 2008 Presidential Candidates or to learn how you can get involved go to: John McCain s Official 2008 Presidential Campaign Web site: www.johnmccain.com/ Barack Obama Official 2008 Presidential Campaign Web site: www.barackobama.com/ APhA Government Affairs Web site www.pharmacist.com/ga 11