criteria to evaluate health care reform proposals

EQUAL Health Network

Access: Criteria for Evaluating Reforms

CRITERIA TO EVALUATE HEALTH CARE REFORM

These criteria can be used to evaluate proposals for health care reform. They include Universal Coverage, Expansion of public programs, Comprehensive Benefits, Affordable, Fair and stable financing, Controls costs, Quality - accessible, appropriate care, Strong public health system, Equitable - addresses disparities in health and health care.

The Center for Policy Analysis evaluated leading health care reform proposals by presidential candidates, and HR 676/Medicare for All, according to these Criteria.

The criteria draw from 4 organizations representing the public interest: Rekindling Reform, a New York coalition; Women LEAD for Health in California; the American Public Health Association; and Raising Women’s Voices, a coalition led by three national women’s health groups.

HEALTH CARE REFORM PROPOSALS: PRESIDENTIAL CANDIDATES COMPARED SEPTEMBER, 2008

[See below for links to: Obama vs. McCain plans; Women’s View; HR 676; More!]

The EQUAL Health Care project of the Center for Policy Analysis has evaluated health care reform proposals by presidential candidates Obama and McCain. The analysis uses the EQUAL Health Care Criteria for Health Care Reform. These criteria summarize a range of basic principles for health care coverage and reform published by 4 organizations representing the public interest: Rekindling Reform, a New York-based coalition; Women LEAD for Health in California; the American Public Health Association; and Raising Women’s Voices, a coalition led by three women’s health groups. The plan features are based on information on the Obama and McCain websites, and other sources. Ellen R. Shaffer, PhD MPH, Co-Director of the Center for Policy Analysis, is the principal author of this comparison, in collaboration with Deborah LeVeen, Professor Emerita, San Francisco State University. The debates on health care reform will also be shaped by Congress. Companion analyses of HR 676 (Conyers) and other legislative proposals are posted here.

SUMMARY:

Criterion

Obama Plan

McCain Plan

GENERAL APPROACH

Aims to provide affordable, comprehensive and portable health coverage to all Americans through a mix of private and expanded public insurance.

Requires all but the smallest employers to offer health benefits or contribute to the cost of a new public health insurance plan. Creates the National Health Insurance Exchange (NHIE) to help small businesses and individuals enroll in the new public plan or in approved private plans.

Requires that all children have health insurance.

Expands Medicaid and SCHIP.

Dramatically restructures the health insurance system. Incentives to reduce or eliminate employment-based group plans, which now cover about 60% of working families. Removes tax breaks to employees and reduces tax breaks to employers for employer-sponsored insurance.

Provides tax credits to individuals ($2,500/year) and families ($5,000/year) to buy insurance. Shifts responsibility to individuals to find and purchase private health insurance. Intends to control costs by creating competition among insurance plans .

Changes payments to providers, promotes tort reform and other measures.

UNIVERSAL COVERAGE

Offers affordable public and private plans to all employers and individuals. Eliminates pre-existing condition exclusions.

Expands Medicaid and SCHIP.

Plan does not aim for universal coverage. Could expand coverage if costs decline.

COMPREHENSIVE BENEFITS

Requires generous benefits, same as for federal employees.

Not specified. Creates incentives to buy plans with bare-bones benefits.

AFFORDABLE

Requires affordable premiums in the new public plan and plans participating in the National Health Insurance Exchange (NHIE). Requires meaningful employer contribution to costs of care. Offers subsidies based on income for premiums.

Tax credits do not cover current insurance costs.

FAIR AND STABLE FINANCING

Requires fair contributions from individuals and employers purchasing insurance, government subsidies for new or expanded coverage, and reinsurance for catastrophic employer costs.

Repeals tax cuts on high-income.

Uses funds from eliminating employee tax breaks for health insurance, and reduced employer tax breaks, to fund tax credits.

Criterion

Obama Plan

McCain Plan

CONTROLS COSTS

Controls premium costs in NHIE plans.

Reduces drug costs through price negotiations in Medicare and encouragement of generics.

Proposes savings through improved quality, cost-effectiveness, and efficiency, including Information Technology (IT).

Relies on individual choice of insurance to drive down costs.

Allows drug reimportation..

Proposes savings through improved quality, cost-effectiveness, and efficiency, including Information Technology (IT).

QUALITY

Improves access to clinical preventive services.

Requires provider transparency for outcomes, quality, prices.

Increases use of Health IT.

Encourages national standards for treatments and outcomes, and research on their effectiveness.

Creates provider incentives for quality.

Restructures payments to encourage coordinated care.

Requires provider transparency for outcomes.

Increases use of Health IT.

Promotes telemedicine and clinics in rural and underserved areas.

Accessible

Supports safety net institutions.

Not addressed.

Appropriate

Increases health care workforce diversity.

Not addressed.

PUBLICLY ACCOUNTABLE

Additional public sector health plan, and administrative assistance through NHIE.

Not addressed.

STRONG PUBLIC HEALTH SYSTEM

Increases funding and coordination of public health.

Modernizes labs.

Invests in workforce.
Increases access to clinical preventive services.

Promotes healthy built environment.

Promotes and strengthens public health and prevention.

Research for care and cure of chronic disease.

Supports public health initiatives to stem obesity and diabetes and deter smoking.

EQUITABLE

Eliminates health disparities

Promotes prevention and public health.

Health plans accountable for differences in quality for disparity populations.

Expands funding and technical resources of safety-net institutions, which provide a disproportionate amount of care for underserved populations.

Not addressed.

Eliminates disparities in the health care workforce

Proposes to diversify the workforce to ensure culturally effective care.

Not addressed.

FEASIBILITY:

Does this already work somewhere?

How much of a change from present U.S. system?

Like this proposal, SCHIP successfully uses public programs to direct uninsured people to a choice of public or private health plans. A number of other public programs offer coverage or care to large populations in the US. Those that are more universal and comprehensive enjoy greater success, such as Medicare, FEHBP, CALPERS, and the VA..

The employer mandate builds on the existing system but would be a significant change.

Market incentives have not succeeded in controlling costs in the U.S. and have been largely abandoned in most other countries.

Elimination or reduction of tax break for employer premiums would be a major change.

COMMENTS:

How well does the plan address criteria?

What does the plan need to improve?

Relatively stronger on coverage, cost control. Strong on affordability, quality, strengthening public health, addressing disparities.

Needs to strengthen incentives and other mechanisms to ensure substantial enrollment in new public plan, to avoid adverse selection.

Does little to improve coverage or control costs. Important measures to improve quality and strengthen public health are undermined by these fundamental flaws. Disparities not addressed.

Needs to prioritize expanding coverage and recognize American experience demonstrating failure of individual choices to control costs.

CPA at Raising Women's Voices, April, 2008:

Policy, Politics and Power: How to Build and Pass the National Health Plan We Want

Dr. Ellen R. Shaffer says women can build towards universal affordable, quality health care in 2008. Newly mobilized voters support change. In their first 100 days, the new President and Congress should commit to protecting and expanding Medicare and SCHIP.

Can We Change the Dems on Universal Health Care? Yes We Can!

Ellen R. Shaffer, PhD MPH Feb. 5, 2008

So many misconceptions – so many months to set them straight.

It’s long past time to end the disgrace of an exorbitantly expensive health care system that leaves so many of us broke and broken. Senators Clinton and Obama deserve credit for broaching this hot topic. But their cautious and complex proposals don’t tackle the heart of the problem: the predatory for-profit health insurance industry that drives up costs, excludes the sick, and too often fails to provide benefits even to people with insurance. It’s like dumping ice cubes on melting Arctic glaciers instead of fixing the holes in the ozone.

Public financing is the only way to ensure that we truly cover everyone, collect from everyone fairly, and rein in health spending. It would spur the nation’s economic recovery and our personal security.

Those of us with a lot at stake and some clout to wield – women, communities of color, union members, employers – should ask candidates to show us realistic and practical first steps on the path to universal and affordable health care, and the grit to unite us against powerful opposition.

CPA: Presidential Candidates Shed Light on Universal Access Debate

On March 24, 2007, presidential candidates made it clear we have come a long way in the 15-year debates on universal access. Since the 1990s:

The failures of market-based approaches to expanding coverage are now well-known - though many candidates still propose them.
The problems are far worse.
The role of public health - income inequality, healthy life options - will be part of the debate.

As before, though, leadership by advocates and candidates will be crucial. Dr. Ellen R. Shaffer, Co-Director of the Center for Policy Analysis, commented:

"Are most presidential candidates proposing universal health care plans that can actually work? Absolutely not. But that's why God gave us 11 months before the first primary....The challenge for the next year and a half for people who use and provide health care, as analysts and as advocates for social justice and public health, as women, communities of color - generally all of us who are eager for something important to start heading the right way in our country for people - this is the year to marshal what we really know, and find out even more, about what works and what can work, to connect that with the political will that already exists, and find out how much farther we can go."

See below for the summary and commentary.

Ellen R. Shaffer: Universal Access: How Can We Influence the National Agenda? Presentation to the Older Women's League, Feb. 24, 2007

EQUAL Health Network

Center for Policy Analysis

San Francisco Presidio

P.O. Box 29586, San Francisco, CA 94129

ph. 415-922-6204 fax 415-885-4091