THE COMMONWEALTH

FUND

Presidential Candidates' Health Care Reform Proposals

Karen DavisPresident, The Commonwealth Fund

AcademyHealth 2008 National Health Policy Conference

February 4, 2008kd@cmwf.org

www.commonwealthfund.org

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THE COMMONWEALTH

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When You Are Deciding Whom to Vote For In Next Year’s When You Are Deciding Whom to Vote For In Next Year’s Presidential Election, How Important Will the Candidate’s Presidential Election, How Important Will the Candidate’s

Views on Health Care Reform Be?Views on Health Care Reform Be?

6277

4760

24

17

3627

0

25

50

75

100

Total Democrat Republican Independent

Somewhat importantVery important

Source: S. R. Collins and J. L. Kriss, The Public's Views on Health Care Reform in the 2008 Presidential Election, The Commonwealth Fund, January 2008

Percent of adults who say candidates’ views on health reform will be very/somewhat important

94

838786

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THE COMMONWEALTH

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Health Insurance Reform and the Presidential Health Insurance Reform and the Presidential Candidates: Three Distinct ApproachesCandidates: Three Distinct Approaches

• Expanded coverage through individual insurance market with tax incentives, changes to employer benefit tax exemption, and deregulation of state markets (Giuliani, Huckabee, McCain, Romney)

• Universal coverage through mixed private–public group insurance with shared responsibility for financing (Clinton, Edwards, Obama)

• Universal coverage through a public insurance program like Medicare (Kucinich)

Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates' Health Reform Proposals, The Commonwealth Fund, January 2008.

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THE COMMONWEALTH

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Where Leading Candidates Stand on Health Care Reform FeaturesWhere Leading Candidates Stand on Health Care Reform FeaturesClinton Edwards Obama Giuliani Huckabee McCain Romney

Most Candidates From Both Parties Agree

Expand coverage X X X X X X X

Health IT X X X X X X X

Transparency X X X X No X X

Malpractice reform X X X X X X X

Prevention X X X X X X No

Some Candidates Agree

Pay for performance X X X No No X No

Candidates Differ

Universal coverage X X X No No No No

Individual mandate X XChildren

only No No No No

Employer pay or play X X X No No No No

Changes to employer benefit tax exemption X No No X Unclear Unclear X

Regulation of insurance markets X X X No No No No

Financing Source X X X No No No No

Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates' Health Reform Proposals, The Commonwealth Fund, January 2008.

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THE COMMONWEALTH

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Public Support for the Proposal That Employers Should Public Support for the Proposal That Employers Should Either Provide Health Insurance to Their Employees or Either Provide Health Insurance to Their Employees or Contribute to a Fund That Would Help Cover Workers Contribute to a Fund That Would Help Cover Workers

Without Health InsuranceWithout Health Insurance

8188

7379

0

25

50

75

100

Total Democrat Republican Independent

Percent of adults who say that employers should either provide health insurance or contribute to a fund

Source: S. R. Collins and J. L. Kriss, The Public's Views on Health Care Reform in the 2008 Presidential Election, The Commonwealth Fund, January 2008

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THE COMMONWEALTH

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Public Support for a Health Reform Proposal That Requires Public Support for a Health Reform Proposal That Requires That Everyone Have Health Insurance, With Government That Everyone Have Health Insurance, With Government

Helping Those Who Cannot Afford It Helping Those Who Cannot Afford It

4050

2538

28

30

27

30

0

25

50

75

100

Total Democrat Republican Independent

Somewhat favorStrongly favor

Percent of adults who strongly/somewhat favor a requirement that everyone have health insurance

80

52

6868

Source: S. R. Collins and J. L. Kriss, The Public's Views on Health Care Reform in the 2008 Presidential Election, The Commonwealth Fund, January 2008

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THE COMMONWEALTH

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Support for Features of Presidential Candidates’ Health Support for Features of Presidential Candidates’ Health Care Reform ProposalsCare Reform Proposals

46

45

39

53

34

35

33

32

39

33

34

44

33

11

17

29

30

32

Strongly Favor Favor

“To what extent do you favor or oppose the following features of the presidential candidates’ health care reform proposals?”

Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.

Mandate health insurance with premium subsidies for low and moderate income

Expand Medicaid and SCHIP to include adults at poverty level or above

Employer pay-or-play mandate

Implement market regulations against risk selection

Include a public plan option like Medicare in new group insurance “connector”

Set a minimum floor on insurance company medical-loss ratios

Allow individuals, small businesses, and associations to buy private insurance across state lines

Administer an individual mandate and income related premium assistance through the tax code

Eliminate the employer benefit tax exemption and replace it with standard income tax deduction or tax

86

83

79

78

71

62

62

52

45

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THE COMMONWEALTH

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65 61

37

11

0

20

40

60

80

100

Allow public

insurance to

compete with

private insurance

Organize and

regulate private

markets with an

insurance connector

Replace private

markets with public

insurance

Preserve private

insurance markets

with reduced

regulation

“Do you think health care reform should…?

Please select all that apply”Percent

Health Care Opinion Leaders Call for Allowing Public Plans Health Care Opinion Leaders Call for Allowing Public Plans Like Medicare to Compete with Like Medicare to Compete with

Private Insurance Private Insurance

Source: Shea, K., S. Collins and K. Davis, Health Care Opinion Leaders’ Views on the Presidential Candidates’ Health Reform Plans, Commonwealth Fund, January 2008.

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Seven in Ten Health Care Opinion Leaders Think the Next President Seven in Ten Health Care Opinion Leaders Think the Next President Should Simultaneously Pursue Universal Coverage and Improve Should Simultaneously Pursue Universal Coverage and Improve

Quality, Efficiency and Cost ControlQuality, Efficiency and Cost Control“Most candidates’ plans also include provisions that would improve quality,

efficiency, and cost control as well as increase coverage. In your view, which of the following provisions should the next president focus on?”

Universal coverage at the same time as policies to improve quality, efficiency

and costs 70%

Not sure3%

Universal coverage first, and then

address quality, efficiency and costs

14%

Address quality, efficiency and costs first and then work on

achieving universal coverage 12%

Source: Shea, K., S. Collins and K. Davis, Health Care Opinion Leaders’ Views on the Presidential Candidates’ Health Reform Plans, Commonwealth Fund, January 2008.

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PanelPanel• Gregg Bloche, Obama for America

• Chris Jennings, Hillary for President

• Tom Miller, John McCain 2008