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Decision 2000 Voter Guide
Despite unprecedented economic prosperity, there are currently over 44
million Americans who lack health care insurance coverage. To address this
problem, the American College of Physicians-American Society of Internal
Medicine (ACP-ASIM) has launched its "Decision 2000" campaign, an effort
aimed at putting the goal of universal health care at the center of the
2000 presidential and congressional election campaigns. The objective is
simple: to have every presidential and congressional candidate pledge to
address the problem of America's uninsured within his or her first year of
taking office. Candidates will not be asked to support any particular
financing mechanism or health care delivery system. Rather, candidates are
asked to pledge themselves to developing a plan to provide accessible
health care coverage by the end of 2001.
This Voter Guide has been developed to assist ACP-ASIM members in
evaluating the presidential and congressional candidates' proposals for
the uninsured. The Guide is divided into three sections:
- The first section outlines ACP-ASIM's criteria for evaluating
proposals to improve our health care system, as published in the
College's 1990 Access to Health Care position paper.
- The second section features questions that should be posed to the
presidential and congressional candidates about their health care
proposals.
- The third section outlines what the presidential candidates have
said about their approaches to solving the problem of the uninsured.
Again, this tool is intended to guide your assessment of the
presidential and congressional candidates' plans to address one of
America's most egregious problems. It is not intended to imply endorsement
of any one plan or candidate.
ACP-ASIM Evaluation Criteria
To evaluate proposals for achieving a better health care system, the
following ACP-ASIM criteria may be useful. These criteria are not intended
to be all inclusive and are listed categorically rather than in order of
importance.
Benefits
- There should be a mechanism for determining the scope of benefits.
- There should be a uniform minimum package of benefits for all.
- Coverage decisions should be based on clinical effectiveness.
- Coverage and benefits should be continuous and independent of place
of residence or employment.
Financing
- Financing should be adequate to eliminate financial barriers to
obtaining needed care.
- There should be mechanisms for controlling costs.
- Administrative expenses and procedures should be minimized.
- Professional liability costs should be minimized.
- Existing sources of revenue should be incorporated into any new
financing system.
Organization and Delivery
- There should be an adequate infrastructure in terms of facilities
and personnel to deliver optimum health care services efficiently and
effectively.
- There should be mechanisms to assure quality.
- Innovation and improvement should be fostered.
- The system should be flexible.
- Incentives should be provided to encourage individuals to take
responsibility for their own health, seek preventive health care, and
pursue health promotion activities.
Satisfaction
- Patients should be satisfied.
- Physicians and other health care professionals should be satisfied.
Candidate Questions
The ACP-ASIM study, "No Health Insurance? It's Enough to Make You Sick"
clearly demonstrates that a lack of health insurance is a significant risk
factor linked to increased illness and premature death. A lack of adequate
access to preventive, diagnostic and therapeutic medical services means
many Americans suffer needlessly from preventable illnesses and
unnecessary death. All physicians have experienced the detrimental impact
that not having insurance has on patients and other individuals in their
communities.
Achieving accessible and affordable health insurance coverage for
all Americans should be a top priority for the presidential and
congressional candidates. While a few candidates have addressed the
problem of the uninsured in their health care proposals, voters need to
continue to ask the candidates what they will do to help the 44 million
Americans without health insurance obtain coverage. By constantly hearing
questions on the problem of the uninsured, candidates will know that this
is an issue of concern to people all across the country.
Voters should ask the candidates the following questions:
- Are you aware of the evidence showing that people without health
insurance coverage are at greater risk of unnecessary suffering and even
premature death?
- If so, do you agree that providing coverage to the uninsured should
be viewed with the same urgency as reducing smoking and other known risk
factors? If not, what do you believe to be a higher priority?
- How do you propose to expand coverage? Are you willing to support a
plan to provide health insurance to all Americans? If so, how long will
it take to reach this goal? If not, who should be left out and why?
- If you are proposing an incremental step-by-step strategy for
expanding coverage, what will be the next steps to get everyone covered
and how long will it take?
Candidate Proposals
Democrats
The Democratic candidate, Al Gore, has unveiled an in-depth, formal
health care proposal, addressing the problem of the uninsured.
Al Gore:
Vice President Gore has offered a modest, incremental plan with a
focused approach. Gore's plan relies on expanding existing government
programs, specifically Medicaid and the State Children's Health Insurance
Program (S-CHIP). Here are the highlights of the Gore plan.
- Gore's plan focuses on expanding access to affordable insurance to
every child by 2005. His plan would expand eligibility in Children's
Health Insurance Program (S-CHIP). S-CHIP is the joint federal/state
sponsored program to expand coverage to children in families with too
much income for Medicaid but too little to afford private insurance.
Gore would expand S-CHIP to children in families with incomes up to 250
percent of the poverty level (about $41,000 for a family of four) to
increase the number of children eligible for the program.
- Gore's plan allows children in families with incomes above 250
percent of poverty that do not have coverage to buy into S-CHIP or
Medicaid. Families would pay the full premium, but the premium will be
more affordable than most individual options.
- To ensure that children eligible for S-CHIP or Medicaid are
enrolled, the Gore plan would provide financial bonuses to states that
meet enrollment targets, would reduce states' S-CHIP enhanced matching
rate if they do not meet these targets and develop a school-based
strategy for enrollment.
- To help the 7 million uninsured parents of Medicaid or
S-CHIP-eligible children, the Gore plan would expand S-CHIP to parents.
States could access higher federal matching payments to cover the
parents of children already enrolling in Medicaid or S-CHIP.
- Gore's plan would allow uninsured people aged 55-65 to buy into
Medicare.
- Gore's plan includes tax credits for 25% of premiums for individuals
buying their own insurance (including seniors buying into Medicare and
parents buying into Medicaid or S-CHIP for themselves or their children)
and for small business joining purchasing coalitions.
- Gore claims his plan will cover an additional 12 million Americans
and would cost $25 billion annually.
The candidate claims:
Gore says his plan addresses the most pressing need, covering uninsured
children. He says the cost of his plan will still leave the government
enough money to address other issues, such as aid for education or
extending the solvency of the Medicare and Social Security programs.
Republicans
The Republican candidate, George W. Bush, has also unveiled a formal
health care proposal, including ways to address the problem of the
uninsured.
George W. Bush:
Governor Bush has also offered a modest, incremental approach to expand
coverage. A key component of the plan is tax credit to cover a percentage
of the nation's uninsured. He has also proposed ways to improve the
country's health care safety net by creating more community health centers
and funding of pilot programs and demonstration projects. Here are the
highlights of the Bush plan.
- Bush proposes a Family Health Credit, a health care tax credit of up
to $1,000 per individual and $2,000 per family to cover up to 90 percent
of the cost of health insurance to individuals and families that do not
receive employer-sponsored coverage and are not eligible for public
programs. As a recipient's income increases, the government's share of
the cost of coverage steadily decreases. The credit can be used only for
the purchase of health insurance, and can be advanced to the insurer
when premiums are due.
- Under Bush' plan, the State Children's Health Insurance Program
(S-CHIP) program would be converted into a more flexible block grant
program. States would be given the freedom to innovate and expand
coverage of the uninsured under S-S-CHIP so that more eligible people
can be reached.
- Bush proposes allowing small businesses to band together, across
state lines, to purchase insurance from bona fide trade associations,
such as the Chamber of Commerce or the NFIB. Association Health Plans
will enjoy the benefits of economies of scale and a larger risk pool.
Proponents of association health plans agree that they will reduce the
cost of health insurance for millions of small businesses and their
employees.
- Bush would allow up to $500 of funds in a Flexible Savings Account
to be carried over from one year to the next.
- The Bush plan would expand and reform Medical Savings Accounts
(MSAs) and make them permanent. He would lift the 750,000 cap on the
number of accounts, and allow all employers to offer an MSA, including
as part of a cafeteria plan. He would also permit both employee and
employer contributions, and lower the minimum deductible to $1,000 for
an individual and $2,000 for family coverage, and permit contributions
up to the deductible.
- The Bush plan would expand federal support for community health
centers by allocating $3.6 million to open 1,200 new community health
centers across the country over five years
- Bush' plan includes a Healthy Communities Innovation Fund-an extra
source of federal support for health care in underserved communities.
This initiative will support pilot programs and demonstration projects
for targeted purposes, such as AIDS education or mental health
awareness.
- Bush claims his plan would cost $40 billion over five years, would
cover up to 18 million of the nation's 44 million uninsured as well as
expand the number of community health centers by 40 percent.
The candidate claims:
Bush says that under his administration, low income Americans will have
access to high quality health care. He believes his Family Health Credit
plan will help buy basic health coverage for every family that is not
already covered by government programs or an employer plan. And by
expanding the reach of community health centers, his plan will improve the
lives and health of millions of Americans.
To learn more about these proposals or the candidates, visit each
individual's campaign web site. A listing of the presidential candidates'
web sites and contact information follows:
Bush, George W. (R)
Bush for President, Inc.
301 Congress
Avenue, Suite 200
Austin, TX 78701
Treasurer: David Herndon
Internet: http://www.georgewbush.com/
Telephone: 512/637-2000
Gore, Al (D)
Gore 2000, Inc.
P.O. Box 23250
Nashville, TN
37202
Treasurer: Jose Villarreal
Telephone: 615/340-2000 |
