[ General Principles for Health Care Reform | Children's Health | Health Insurance Mandates | Single Payer System | Tax Law Reforms/Subsidies | Expansion of Public Programs | Cuts to Medicare/Medicaid | Insurance Pooling | Physician Workforce | Medical Homes | Preventive Medicine | State Flexibility | Pay-for-Performance | Managed Care/Insurance Company Regulation | Mental Health | Health Information Technology (HIT) | ERISA | Access to Care in Rural/Underserved Areas | Health Care Cost Containment | Transparency | HSAs ]
General Principles for Health Care Reform
Barack Obama
Require all children to have health insurance, and employers to offer employee health benefits or contribute to the cost of the new public program. Create a new public plan, and expand Medicaid and SCHIP. Create the National Health Insurance Exchange through which small businesses and individuals without access to other public programs or employer-based coverage could enroll in the new public plan or in approved private plans.
John McCain
Remove the favorable tax treatment of employer-sponsored insurance and provide a tax credit to all individuals and families to increase incentives for insurance coverage; promote insurance competition; and contain costs through payment changes to providers, tort reform, and other measures.
TMA Policy
TMA supports a pluralist approach to health care reform, blending best practices from the private and public sectors to ensure universal access to affordable, high-quality health care services.
Top of page
Children's Health
Barack Obama
Require all children to have health insurance, and employers to offer employee health benefits or contribute to the cost of the new public program. Covering children would be achieved both by expanding CHIP and by creating a new system similar to the Federal Employees Health Benefit Program.
John McCain
Nothing specifically, but plan specifies the following: 1) CHIP and other public health programs should be limited to low-income residents only; 2) address public health priorities including obesity and smoking; 3) provide tax incentives for low-income people so they can afford to buy health coverage. All individuals would receive a $2,500 refundable tax credit (up to $5,000 for a family) for insurance coverage. (4) Support Autism research.
TMA Policy
Extensive policy addressing health insurance coverage, prevention, mental health care, and safety of children. TMA supports efforts to streamline enrollment in Medicaid and CHIP for children who are eligible but not enrolled, including ensuring 12 months' continuous coverage for both programs, as well as use of tax credits to help higher-income families purchase private health care coverage.
Top of page
Health Insurance Mandates
Barack Obama
Require all children to have health insurance, and employers to offer employee health benefits or contribute to the cost of the new public program.
John McCain
Opposes mandates for coverage.
TMA Policy
TMA believes the inclusion of employer mandates would significantly increase costs to small businesses and ultimately result in the loss of jobs (145.002).
Top of page
Single Payer System
Barack Obama
None
John McCain
None
TMA Policy
Single payer systems are not in the best interest of the public, physicians, or the health care of the nation (145.005) 2) Private, individualized medical care and free enterprise insurance mechanisms which involve a specific degree of direct patient responsibility within and allow pluralistic, free choice options offer the highest quality of medical care at the lowest possible cost (110.003).
Top of page
Tax Law Reforms/Subsidies
Barack Obama
(1) Make federal income-related subsidies available to help individuals buy the new public plan or other qualified insurance. (2) Federal subsidies would partially reimburse employers for their catastrophic health care costs if the employers guaranteed that premium savings would be used to reduce employee premiums.
John McCain
(1) Provide a tax credit of $2,500 (individuals) and $5,000 (families) to all individuals and families for the purchase of insurance. (2) Require any state receiving Medicaid to develop a financial "risk adjustment" bonus for high-cost and low-income families to supplement tax credits and Medicaid funds. (3) Reform the tax code to eliminate bias toward employer-sponsored health insurance. (4) Allow individuals owning "innovative multiyear policies" that cost less than the credit to deposit the excess into expanded HSAs.
TMA Policy
1) TMA emphasizes the importance of ensuring that health care coverage is affordable to each and every citizen using their own resources, employer contributions, taxing incentives, or federal supplementation where indicated (115.006). (2) TMA is committed to a national legislative initiative promoting health care costs as a tax deductible item regardless of whether the cost is incurred by an employer or an individual (110.008). (3) TMA supports tax law reforms which increase the tax-preferenced insurance and spending choices available to patients, encourage individuals to buy insurance and set aside funds for medical needs, provide subsidies to those who are most in need and encourage personal responsibility and participation of patients in the financing and benefit design decision that ultimately determine their health benefit coverage (110.009).
Top of page
Expansion of Public Programs
Barack Obama
(1) Expand Medicaid and SCHIP. (2) Create a new public plan so that small businesses and individuals without access to other public programs or employer-based coverage could purchase insurance. Plan coverage would offer comprehensive benefits similar to those available through FEHBP. (3) Coverage would be portable.
John McCain
Give veterans ability to use their VA benefits to pay for timely, high-quality care from providers in the best locations.
TMA Policy
Any national initiative to expand health insurance should be predicated predominantly on strengthening the private insurance system and promoting individual ownership and responsibility, recognizing that a portion of the population will always need some level of government subsidy to obtain and maintain coverage. TMA remains a strong supporter of the CHIP program as a best practice example of public-private partnerships to expand coverage.
Top of page
Cuts to Medicare/Medicaid
Barack Obama
None
John McCain
No cuts mentioned. Wants to reform the payment system to compensate providers for diagnosis, prevention and care coordination. Medicaid and Medicare should not pay for preventable medical errors or mismanagement.
TMA Policy
TMA opposes cuts in the Medicare and Medicaid programs to finance any health system reform plans (120.007).
Top of page
Insurance Pooling
Barack Obama
Create a National Health Insurance Exchange through which individuals could purchase the public plan or qualified private insurance plans. Require participating insurers to offer coverage on a guaranteed issue basis, charge a fair and stable premium that is not rated on the basis of health status, and meet standards for quality and efficiency. Require plans of participating insurers to offer coverage at least as generous as the new public plan. Exchange would evaluate plans and make differences among them transparent.
John McCain
Establish a nonprofit corporation that would contract with insurers to cover patients who have been denied insurance and could join with other state plans to enlarge pools and lower overhead costs (this is one option proposed under McCain's Guaranteed Access Plan or GAP). Allow association plans that meet standards and certification requirements.
TMA Policy
TMA opposes the establishment of mandated health alliances or health care purchasing cooperatives. TMA supports (1) adequate funding for medical schools to conduct medical education research and address primary care needs, and (2) that state, regional, and national needs, in conjunction with the special expertise and excellence of medical training centers, be considered when evaluating any plan for health system reform (180.006).
Top of page
Physician Workforce
Barack Obama
Will expand funding—including loan repayment, adequate reimbursement, grants for training curricula, and infrastructure support to improve the primary care and public health workforce.
John McCain
None
TMA Policy
TMA adopted recommendations by the Task Force on Access to Health Care in Texas in Code Red—the Health of Texas, April 2006 as follows: 1) Texas should increase the number of physicians annually graduating from its medical schools by 20 percent over the next decade. 2) Texas should expand medical school loan repayment programs for graduates of Texas medical schools working in Texas to include up to 500 physicians per year. 3) State support of medical residency programs should allow an increase in residency positions by 600 per biennium for the next decade.
Top of page
Medical Homes
Barack Obama
Encourages integrative care through implementation of medical home models.
John McCain
None
TMA Policy
TMA promotes the use of a medical home for all patients to coordinate and manage preventive, primary, specialty, and ancillary services and to ensure more cost-effective use of resources.
Top of page
Preventive Medicine
Barack Obama
Improve prevention and management of chronic conditions in an effort to contain health care costs.
John McCain
1) Invest in prevention and care of chronic illnesses. 2) Promote the availability of smoking cessation programs by working with business and insurance companies to promote availability.
TMA Policy
TMA supports universal access to clinical preventive services for all Americans and believes that clinical preventive services of proven effectiveness, delivered in a cost-efficient manner, should be included in insurance benefits for a well population (260.029).
Top of page
State Flexibility
Barack Obama
Maintain existing state health reform plans if they meet minimum standards of the national plan.
John McCain
Give states flexibility and encouragement to experiment with: 1) Use of private insurance and risk-adjusted payments per episode under Medicaid; and 2) alternative forms of access, insurance policies, and providers, and different licensing schemes for providers. Under the Guaranteed Access Plan, he would work with governors to develop a best practice model that states can follow. It would reflect the best experience of the states to ensure that patients have access to health coverage.
TMA Policy
Any proposals for health system reform must address economic, demographic, and regional differences in the health care needs of the states (120.009).
Top of page
Pay-for-Performance
Barack Obama
Will accelerate efforts to develop and disseminate best practices, and align reimbursement with provision of high-quality health care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare, and FEHB will be rewarded for achieving performance thresholds on physician-validated outcome measures.
John McCain
Promote competition among providers by paying them only for quality.
TMA Policy
Common quality measures, that can be standardized across all payment systems as well as the American Board of Medical Specialties maintenance of certification and state licensure requirements, should be developed based on evidence-based clinical guidelines (265.014).
Top of page
Managed Care/Insurance Company Regulation
Barack Obama
1) Prohibit insurers from denying coverage based on pre-existing conditions. 2) Children up to age 25 could continue family coverage through their parents' plan. 3) In market areas where there is not enough competition, require insurers to pay out a reasonable share of premiums on patient care benefits. 4) Prevent insurers from abusing monopoly power through unjustified price increases. 5) Require health plans to disclose the percentage of their premiums that actually goes to paying for patient care as opposed to administrative costs.
John McCain
1) Promote competition and individual choice of insurance by allowing insurance to be sold across state lines. 2) Encourage innovative multiyear insurance products. 3) Allow small businesses and the self-employed to purchase insurance through any organization or association. Such entities would have to meet rigorous standards and certification. Coverage would be portable and would bridge the time between retirement and Medicare eligibility.
TMA Policy
TMA (1) supports the concept of universal access to appropriate health care; (2) supports freedom of patients to select their own physicians; (3) supports meaningful professional liability reform for physicians as a key element of health system reform; (4) supports genuine relief from red-tape hassles and excessive administrative costs of health care; (5) supports freedom from unreasonable restrictions, including antitrust prohibitions, that prevent physicians from conducting peer review of quality and fees; (6) continues to support a health care system that includes a multiplicity of funding sources and payment mechanisms; (7) supports the right of a physician organization to negotiate at the federal or state level for payment of physician services, quality and utilization review, professional liability reform, and to reduce the hassle and cost of regulation; (8) continues to support sufficient autonomy for physicians to be advocates for patients and to make decisions in the best interests of their patients; (9) supports efforts to control costs in an efficient and effective manner that considers the needs of patients and allows the exercise of good medical judgment; (10) supports the funding of research and medical education in any health system reform proposal and believes that all corporate payers of health care share in the costs of graduate medical education; (11) supports quality assurance through practice parameters and outcomes research; (12) supports patient responsibility for first dollar coverage to allow patients to make individual decisions regarding their own health care spending with consideration given to patients’ ability to pay (120.003).
Top of page
Mental Health
Barack Obama
Supports mental health parity so that coverage for serious mental illnesses is provided on the same terms and conditions as other illnesses and diseases.
John McCain
Where cost-effective, place mental health clinics in areas where services and providers are limited.
TMA Policy
TMA (1) supports mental health equitable treatment (parity) of health insurance coverage for psychiatric brain disease and malfunction (mental illness including substance abuse/chemical dependency) equal to that for other medical conditions; (2) continues to educate members, patients, and the media about the efficacy and cost-effectiveness of treatments for psychiatric brain disease and malfunction, and about the congressional bills being debated; (3) continues to lobby the Texas Legislature to increase the scope of its limited parity law to include all psychiatric illnesses that significantly affect the quality of life and functioning of its citizens; and (4) continues to strive to overcome barriers to access of mental health care for the uninsured, as well as for policyholders whose health plans exclude or discourage optimal care (145.019).
Top of page
Health Information Technology (HIT)
Barack Obama
Invest $50 billion toward adoption of electronic medical records and other HIT.
John McCain
Promote deployment of HIT.
TMA Policy
The Texas Medical Association (1) supports legislation and other appropriate initiatives that provide positive incentives for physicians to acquire health information technology (HIT), (2) pursues legislative and regulatory changes through its activities in the federation to obtain an exception to law that permits hospitals and other entities to provide financial assistance to physicians purchasing HIT, and (3) supports initiatives to ensure compatibility among all HIT systems (265.012).
Top of page
ERISA
Barack Obama
None
John McCain
None
TMA Policy
In collaboration with the AMA, other state medical associations, and other similarly affected stakeholders: propose and actively support federal legislation clarifying that ERISA pre-emption does not apply to physician/insurer contracting issues; develop, propose, and actively support federal legislation that requires all third-party payers serving as administrators for ERISA plans to accept assignment of benefits by patients to physicians; and develop and support federal and state legislation prohibiting "all products" clauses or linking participation in one product to participation in other “tied” products administered or offered by third- party payers or their affiliates (180.032).
Top of page
Access to Care in Rural/Underserved Areas
Barack Obama
Support and expand the capacity of safety-net institutions that provide a disproportionate amount of care for underserved populations with inadequate funding and technical resources.
John McCain
Where cost-effective, employ telemedicine and community and mental health clinics in areas where services and providers are limited. Expand use of retail health clinics.
TMA Policy
TMA will continue to focus efforts on resolving the maldistribution of physicians by encouraging physicians to locate in underserved areas of the state (185.001).
Top of page
Health Care Cost Containment
Barack Obama
1) Invest $50 billion toward adoption of electronic medical records and other HIT. 2) Promote insurer competition through the National Health Insurance Exchange and by regulating the portion of health plan premiums that must be paid out in benefits. 3) Improve prevention and management of chronic conditions. 4) Initiate policies to promote generic drugs, allow drug reimportation, and repeal the ban on direct price negotiation between Medicare and drug companies. 5) Pay Medicare Advantage plans the same as traditional Medicare. 6) Require hospitals and providers to publicly report measures of health care costs and quality. 7) Promote and strengthen public health and prevention. 8) Reform medical malpractice while preserving patient rights by strengthening antitrust laws and promoting new models for addressing physician errors.
John McCain
1) Adopt malpractice reforms that limit frivolous lawsuits and excessive damages. 2) Promote competition among providers by paying them only for quality and promote use of alternative providers (e.g., nurse practitioners) and treatment settings (retail outlets). 3) Provide for vigorous enforcement of federal protections against collusion, unfair business, and consumer practices. 4) Invest in prevention and care of chronic illnesses. 5) Increase competition and reduce administrative overhead costs of private insurance by permitting sale of nationwide insurance. 6) Require drug companies to reveal the price of their drugs; allow reimportation of drugs; and encourage faster introduction of generics and biologics. 7) Provide consumers with more information on treatment options and require provider transparency regarding medical outcomes.
TMA Policy
TMA emphasizes health system reform with cost control reform measures that protect the freedom of access and the quality of medical care to patients and leaves government in the subordinate position and role of taxation and funding (120.002).
Top of page
Transparency
Barack Obama
1) Require hospitals and providers to collect and publicly report measures of health care costs and quality including data on preventative medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. 2) Health plans will be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.
John McCain
Provide consumers more information on treatment options and require provider transparency regarding medical outcomes, quality of care, costs, and prices. Facilitate the development of national standards for measuring and recording treatments and outcomes.
TMA Policy
1) Require health insurance to disclose accurate, current, and honest information to employers and employees on co-pays, deductibles, and health plan networks. 2) Oppose any measure requiring transparency that does not treat all health entities -- health insurance companies, hospitals, pharmacies, and physicians -- equally. 3) Require health plans to disclose patient data when medical services are provided. 4) Require health plans to use evidence-based tools to measure the quality and efficiency of care (2007 Legislative One-pager).
Top of page
HSAs
Barack Obama
None
John McCain
Expand the benefits of Health Savings Accounts
TMA Policy
TMA voted to weigh heavily in its evaluation of health care reform proposals the following concepts: establish tax credits for deposits into HSAs from which individuals would use their own money to pay small medical expenses without penalty (120.001).
Top of page
Sources: Kaiser Family Foundation Health '08; Council for Affordable Health Insurance; TMA policy manual.
Last Published: 8/26/2008
Print this page