Issue Position: Health Care

Issue Position

By:  Barack Obama II
Location: Unknown

Plan for a Healthy America

"We now face an opportunity — and an obligation — to turn the page on the failed politics of yesterday's health care debates… My plan begins by covering every American. If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don't have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness."

— Barack Obama, Speech in Iowa City, IA, May 29, 2007

The Problem

Millions of Americans are uninsured or underinsured because of rising medical costs: 46 million Americans — including over 8 million children — lack health insurance with no signs of this trend slowing down.

Health care costs are skyrocketing: Health insurance premiums have risen 4 times faster than wages over the past 6 years.

Too little is spent on prevention and public health: The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health.

Barack Obama and Joe Biden's Plan

Quality, Affordable and Portable Coverage for All

* The Obama-Biden Plan to Cover Uninsured Americans: Obama and Biden will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress. The Obama-Biden plan will have the following features:
1. Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.
2. Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.
3. Affordable premiums, co-pays and deductibles.
4. Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
5. Simplified paperwork and reined in health costs.
6. Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
7. 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.
8. Quality and efficiency. Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology and administration are being met.
* National Health Insurance Exchange: The Obama-Biden plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group 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. 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 have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.
* Employer Contribution: Employers that do not offer 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, and will receive a new Small Business Health Tax Credit that helps reduce health care costs for small businesses.
* Support for Small Businesses: 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. 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.
* Mandatory Coverage of Children: Obama and Biden will require that all children have health care coverage. Obama and Biden will expand the number of options for young adults to get coverage, including allowing young people up to age 25 to continue coverage through their parents' plans.
* Expansion Of Medicaid and SCHIP: Obama and Biden will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function.
* Flexibility for State Plans: Due to federal inaction, some states have taken the lead in health care reform. The Obama-Biden plan builds on these efforts and does not replace what states are doing. States can continue to experiment, provided they meet the minimum standards of the national plan.

Lower Costs by Modernizing The U.S. Health Care System

* Reducing Costs of Catastrophic Illnesses for Employers and Their Employees: Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. 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.

* Helping Patients:
1. Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama and Biden will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.
2. Coordinate and integrate care. Over 133 million Americans have at least one chronic disease and these chronic conditions cost a staggering $1.7 trillion yearly. Obama and Biden will support implementation of programs and encourage team care that will improve coordination and integration of care of those with chronic conditions.
3. Require full transparency about quality and costs. Obama and Biden will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

* Ensuring Providers Deliver Quality Care:
1. Promote patient safety. Obama and Biden will require providers to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.
2. Align incentives for excellence. Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded for achieving performance thresholds on outcome measures.
3. Comparative effectiveness research. Obama and Biden will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have the accurate and objective information they need to make the best decisions for their health and well-being.
4. Tackle disparities in health care. Obama and Biden will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. They will also challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and diversification of the health workforce.
5. Insurance reform. Obama and Biden will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctor-patient relationship and reduce the need for malpractice suits.
* Lowering Costs Through Investment in Electronic Health Information Technology Systems: Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama and 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, and will phase in requirements for full implementation of health IT. Obama and Biden will ensure that patients' privacy is protected.
* Lowering Costs by Increasing Competition in the Insurance and Drug Markets: The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. There have been over 400 health care mergers in the last 10 years, and just two companies dominate a full third of the national market. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed by over 87 percent.

1. Barack Obama and Joe Biden will prevent companies from abusing their monopoly power through unjustified price increases. Their plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. Their new National Health Exchange will help increase competition by insurers.
2. Lower prescription drug costs. The second-fastest growing type of health expenses is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama and Biden will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama and Biden will also repeal the ban that prevents the government from negotiating with drug companies, which could result in savings as high as $30 billion. Finally, Obama and Biden will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big name drug companies from keeping generics out of markets.

Fight for New Initiatives

* Advance the Biomedical Research Field: As a result of biomedical research the prevention, early detection and treatment of diseases such as cancer and heart disease is better today than any other time in history. Barack Obama and Joe Biden have consistently supported funding for the national institutes of health and the national science foundation. They strongly support investments in biomedical research, as well as medical education and training in health-related fields, because it provides the foundation for new therapies and diagnostics. They have been champions of research in cancer, mental health, health disparities, global health, women and children's health, and veterans' health. As president, Obama will strengthen funding for biomedical research, and better improve the efficiency of that research by improving coordination both within government and across government/private/non-profit partnerships. An Obama-Biden administration will ensure that we translate scientific progress into improved approaches to disease prevention, early detection and therapy that is available for all Americans.
* Fight AIDS Worldwide. There are 33 million people across the planet infected with HIV/AIDS. As president, Obama will continue to be a global leader in the fight against AIDS. Obama believes in working across party lines to combat this epidemic and recently joined Senator Sam Brownback (R-KS) at a large California evangelical church to promote greater investment in the global AIDS battle.
* Support Americans with Disabilities: As a former civil rights lawyer, Barack Obama knows firsthand the importance of strong protections for minority communities in our society. Obama and Biden are committed to strengthening and better enforcing the Americans with Disabilities Act (ADA) so that future generations of Americans with disabilities have equal rights and opportunities. Obama and Biden believes we must restore the original legislative intent of the ADA in the wake of court decisions that have restricted the interpretation of this landmark legislation.

Barack Obama and Joe Biden are also committed to ensuring that disabled Americans receive Medicaid and Medicare benefits in a low-cost, effective and timely manner. Recognizing that many individuals with disabilities rely on Medicare, Obama worked with Senator Ken Salazar (D-CO) to urge the department of health and human services to provide clear and reliable information on the Medicare prescription drug benefit and to ensure that the Medicare recipients were protected from fraudulent claims by marketers and drug plan agents.
* Improve Mental Health Care. Mental illness affects approximately one in five American families. The National Alliance on Mental Illness estimates that untreated mental illnesses cost the U.S. more than $100 billion per year. As president, Obama will support mental health parity so that coverage for serious mental illnesses are provided on the same terms and conditions as other illnesses and diseases.
* Protect Our Children from Lead Poisoning. More than 430,000 American children have dangerously high levels of lead in their blood. Lead can cause irreversible brain damage, learning disabilities, behavioral problems, and, at very high levels, seizures, coma and death. As president, Obama will protect children from lead poisoning by requiring that child care facilities be lead-safe within five years.
* Reduce Risks of Mercury Pollution. More than five million women of childbearing age have high levels of toxic mercury in their blood, and approximately 630,000 newborns are born at risk every year. Barack Obama and Joe Biden have a plan to significantly reduce the amount of mercury that is deposited in oceans, lakes, and rivers, which in turn would reduce the amount of mercury in fish.
* Support Americans with Autism. More than one million Americans have autism, a complex neurobiological condition that has a range of impacts on thinking, feeling, language, and the ability to relate to others. As diagnostic criteria broaden and awareness increases, more cases of autism have been recognized across the country. Barack Obama and Joe Biden believe that we can do more to help autistic Americans and their families understand and live with autism. He has been a strong supporter of more than $1 billion in federal funding for autism research on the root causes and treatments, and he believes that we should increase funding for the Individuals with Disabilities Education Act to truly ensure that no child is left behind.

More than anything, autism remains a profound mystery with a broad spectrum of effects on autistic individuals, their families, loved ones, the community, and education and health care systems. Obama and Biden believe that the government and our communities should work together to provide a helping hand to autistic individuals and their families.

Barack Obama's Record

* Health Insurance: In 2003, Barack Obama sponsored and passed legislation that expanded health care coverage to 70,000 kids and 84,000 adults. In the U.S. Senate, Obama cosponsored the Healthy Kids Act of 2007 and the State Children's Health Insurance Program (SCHIP) Reauthorization Act of 2007 to ensure that more American children have affordable health care coverage.
* Women's Health: Obama worked to pass a number of laws in Illinois and Washington to improve the health of women. His accomplishments include creating a task force on cervical cancer, providing greater access to breast and cervical cancer screenings, and helping improve prenatal and premature birth services.