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FOR A HEALTHY AMERICA: LOWERING HEALTH CARE COSTS AND ENSURING AFFORDABLE, HIGHQUALITY HEALTH CARE FOR ALL
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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.
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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.
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TO LOWER HEALTH CARE COSTS AND ENSURE AFFORDABLE, ACCESSIBLE HEALTH COVERAGE FOR ALL
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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 care.5 care.1 Nearly 11 million insured spent more than a quarter of their salary on health care last year.6 And over Over bills.7 bills.2 year.8 Prescription drug errors alone cost the nation more than $100 billion every year.9 year.3 costs costs, costs.10
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costs.4
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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.
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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. health.12 health.8 BARACK OBAMA AND JOE BIDEN'S PLAN FOR A HEALTHY AMERICA
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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:
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(1) Providing affordable, comprehensive and portable health coverage for every American;
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(2) Modernizing the U.S. health care system to contain spiraling health care costs and improve the quality of patient care; and
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(3) Promoting prevention and strengthening public health, to prevent disease and protect against natural and man-made disasters.
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Under the Obama-Biden plan, the typical family will save up to $2,500 every year through:
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.. Health IT investment, which will reduce unnecessary spending in the system that results from preventable errors and inefficient paper billing systems;
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.. Improving prevention and management of chronic conditions;
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.. Increasing insurance industry competition and reducing underwriting costs and profits, which will reduce insurance overhead;
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.. Providing reinsurance for catastrophic coverage, which will reduce insurance premiums; and
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.. Making health insurance universal, which will reduce spending on uncompensated care
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QUALITY, AFFORDABLE & PORTABLE HEALTH COVERAGE FOR ALL
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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.
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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.
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(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.
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The plan will have the following features:
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.. Guaranteed eligibility. No American will be turned away FROM ANY INSURANCE PLAN because of illness or pre-existing conditions.
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.. 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.
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.. Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services.
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.. 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.
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.. Simplifying paperwork and reining in health costs. The plan will simplify paperwork for providers and will increase savings to the system overall.
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.. Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
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.. 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.
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.. 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.
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(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.
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(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.
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(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.
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(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.
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(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.
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(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.
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MODERNIZING THE U.S. HEALTH CARE SYSTEM TO LOWER COSTS & IMPROVE QUALITY
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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
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OBAMA-BIDEN PLAN TO PROVIDE AFFORDABLE, ACCESSIBLE HEALTH CARE TO ALL
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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.
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LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM WORK FOR PEOPLE AND BUSINESSES -- NOT JUST INSURANCE COMPANIES
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year.19 year.9 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.
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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 Some researchers estimate that as much as 30 percent of health care is not contributing materially to patient outcomes.21 of the costs the cost country.22 The key is to provide information, incentives, country.12 The key is to provide information, incentives of care dramatically 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 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.
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(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.
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(2) LOWERING COSTS BY ENSURING PATIENTS RECEIVE AND PROVIDERS DELIVER QUALITY CARE. employees.
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(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
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(2) IMPROVE ACCESS TO PREVENTION AND PROVEN DISEASE MANAGEMENT PROGRAMS. HELPING HELP pressure.25 pressure.15 need.26 need.16 decades.27 decades.17 disease.28 disease.18 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 about regarding information.31 information.20 care, care ENSURING PROVIDERS DELIVER QUALITY CARE
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.. Promoting ENSURE PROVIDERS DELIVER QUALITY CARE
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.. Promote occurrences.
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.. Aligning errors.
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.. Align care.32 care.21 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. Comparative effectiveness studies provide crucial information about which drugs, devices and procedures are the best diagnostic and treatment options for individual patients. Tackling Tackle 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. health (see below), health, safetynet safety-net Reforming Reform medicine37 and raising the costs of health care for everyone38. medicine22 and raising the costs of health care for everyone.23 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
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(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. quo, quo competition. competition in the insurance industry. Other not-for-profits found business so lucrative, they converted to for-profit companies. years, years 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 years.44 years.25 percent.45 percent.26 bonuses.46 bonuses.27 also 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.
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.. Allow consumers to import safe drugs from other countries. drugs.47 drugs.29 premium.48 premium.30 Increasing use of generics.
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.. Prevent drug companies from blocking generic drugs from consumers. products.49 products.31 Lowering Medicare prescription drug benefit costs. .. Allow Medicare to negotiate for cheaper drug prices. pharmaceutical drug taxpayers.50 taxpayers.32 billion,51 billion,33 .. 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.
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(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.
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AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL
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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.
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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.
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(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.
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(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.
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The Exchange will have the following features:
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.. 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.
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.. Affordable premiums, co-pays and deductibles. Participants will be charged fair premiums and minimal co-pays for deductibles for preventive services.
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.. Simplified paperwork. The plan will simplify paperwork for providers and will increase savings to the system overall.
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.. Easy enrollment. All Exchange health insurance plans will be simple to enroll in and provide ready access to coverage.
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.. Portability and choice. Participants will be able to move from job to job without changing or jeopardizing their health care coverage.
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.. 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.
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(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.
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(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.
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(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.
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(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.
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(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.
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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. Americans.133 million.have Americans--133 million--have 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 diabetes.cause over two-thirds of all deaths each year.55 diabetes--cause over two-thirds of all deaths each year.39 growing.56 growing.40 And these traditional public health functions have evolved to include disaster preparedness and response for both natural and man-made disasters. Each All parties their they 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 lunches.62 lunches.43 schoolbased school-based dwindling,63 dwindling,44 about for funding.including funding--including conditions. conditions-- 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
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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 Barack Obama and Joe Biden will ensure that all Americans are empowered to monitor their health by ensuring coverage of essential clinical vegetables, vegetables; health, health nation,66 nation,45