1. Healthcare Coverage for All Americans By 2010
The American College of Cardiology (ACC) strongly believes that every American should have a basic and adequate level of health care coverage, and that a stepwise plan should be developed as soon as possible to ensure coverage for all by the year 2010.

Coverage should be achieved by following an incremental and sequential strategy that emphasizes securing coverage for the lowest income children and families first (e.g. up to 250% of poverty)—by expanding upon the current state-based safety net infrastructure, e.g., extending eligibility for current programs including Medicaid and the State Children's Health Insurance Program (SCHIP), and eventually extending coverage to all low income individuals.

Our ultimate goal is for coordinated approaches that provide an affordable basic benefits package for all Americans and preserve choice of health plan. Supplemental coverage should then be available above that basic level for those who desire it.

The ACC supports using new, available public funds for incremental expansions of existing health care programs including an expansion of the Medicare program to provide a prescription drug benefit for Medicare beneficiaries; and other programs, such as an expansion of the SCHIP program (Title XXI) to cover uninsured adults.

2. Infrastructure Supporting Individual And Small Group Insurance Purchasing
Small groups and individuals should have the ability to obtain insurance at rates similar to those of large employers who enjoy substantial volume discounts, and should benefit from similar tax deductibility.

To achieve this "fairness" in the marketplace, the ACC believes the most viable approach is to enable individuals and small businesses to purchase coverage through purchasing agents or cooperatives that can serve as the "pooling" mechanism to spread risk and thus lower consumer costs. These regional or state-based cooperatives should be structured in a fashion similar to the Federal Employees Health Benefits Plan (FEHBP) or SCHIP, through which an array of plan choices are offered. There would be a community-based rate for all adults (age and gender adjusted, if necessary, but not related to disease) and another rate for children. Plans would have to qualify for participation in the cooperatives based on quality and cost.

To increase access to health care insurance for the working poor, and those not covered by other programs, the ACC supports direct payments (e.g. in the form of refundable tax credits), to be offered on a sliding scale basis inversely related to income, and contingent upon the purchase of health insurance. The amount of these credits should be linked to the premium required for a basic benefits package, so that low-income families can afford to provide health care for their families.

3. Public-Private Partnership
The American College of Cardiology believes that the most realistic, workable approach to providing coverage for all Americans is through a partnership that combines the strengths of both the public and private sectors. Any sequential health system reform effort should initially retain employer funding of employees. However, to encourage individual participation and accountability; employers should provide an array of choices including defined contribution, where employees could purchase coverage through a purchasing cooperative.

Funding for safety net facilities should be increased to enable the continued provision of care to the poor, until all are covered by other means.

4. Shared Accountability for Improved Health among Purchasers, Payers, Providers and Patients
The ACC believes that health care is a shared responsibility among purchasers, payers, providers and patients.

All parts of the financing and delivery system must, therefore, work together, and be accountable to improve health by: increasing enrollment and access to current public programs (e.g. Medicaid, SCHIP); addressing ethical behavior by purchasers, providers and patients; and creating incentives for providers and patients to improve health and healthy behavior.

When affordable options for healthcare are made available, all citizens should be required to take advantage of them.

5. Emphasis on Quality and Administrative Simplification
The ACC strongly believes that physicians, health care professionals and other providers have a responsibility for ensuring quality of care. Any health system reform effort should emphasize the greatest possible value in health care (highest quality for the available funding). We support continued work toward quality improvement through the encouragement and practice of evidence-based medicine, the establishment of "best practice" documents—practice guidelines; reduction in practice variation where appropriate; reduction in medical errors; and consistent quality assurance monitoring.

The health system should also focus resources on improving quality health care through appropriate public funding of medical education and research.

The ACC further recognizes that non-medical aspects of care also contribute to overall quality of care. Efforts to ease burdensome administrative requirements should be a primary focus of a reformed health care system. Administrative simplification should be achieved for patients and providers through the development and implementation of automated billing and payment systems linked to electronic medical records. To ease the selection and purchase of insurance, systems should be established through which individualized electronic report cards can be generated that are understandable to patients, enabling them to compare only those items, e.g., specific quality measures, copays, deductibles that are of greatest interest to them. Physicians should work with their patients, both teaching them, and learning from them, how to recognize quality.

Provide Your Input
The ACC considers this statement of principles a moving target and intends to readdress portions of the statement as necessary. If you have comments, concerns and/or questions, please e-mail advocacydiv@acc.org. Thank you.