THE
COMMONWEALTH
FUND
Presidential Candidates' Health Care
Reform Proposals
Karen Davis
President, The Commonwealth Fund
AcademyHealth 2008
National Health Policy Conference
February 4, 2008
kd@cmwf.org
www.commonwealthfund.org
When You Are Deciding Whom to Vote For In Next
Year’s Presidential Election, How Important Will the
Candidate’s Views on Health Care Reform Be?
2
Percent of adults who say candidates’ views on health reform will be
very/somewhat important
Somewhat important
Very important
94
100
87
86
83
17
75
24
36
27
50
25
62
77
47
60
0
Total
Democrat
Republican
Independent
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
THE
COMMONWEALTH
FUND
3
Health Insurance Reform and the Presidential
Candidates: 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)
THE
COMMONWEALTH
FUND
Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates' Health Reform Proposals,
The Commonwealth Fund, January 2008.
Where Leading Candidates Stand on Health Care Reform Features
Clinton
Edwards
Obama
Giuliani
Huckabee
McCain
Romney
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
X
X
X
No
No
X
No
Universal coverage
X
X
X
No
No
No
No
Individual mandate
X
X
Children
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
Financing Source
X
X
X
No
No
No
4
Most Candidates From
Both Parties Agree
Some Candidates
Agree
Pay for
performance
Candidates Differ
Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates' Health Reform Proposals, The Commonwealth Fund, January 2008.
THE
No
COMMONWEALTH
FUND
No
Public Support for the Proposal That Employers 5
Should Either Provide Health Insurance to Their
Employees or Contribute to a Fund That Would Help
Cover Workers Without Health Insurance
Percent of adults who say that employers should either provide health
insurance or contribute to a fund
100
81
88
73
75
79
50
25
0
Total
Democrat
Republican
Independent
THE
COMMONWEALTH
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
6
Public Support for a Health Reform Proposal That
Requires That Everyone Have Health Insurance, With
Government Helping Those Who Cannot Afford It
Percent of adults who strongly/somewhat favor a requirement that
everyone have health insurance
Somewhat favor
Strongly favor
100
75
50
80
68
30
28
68
52
30
27
25
40
50
25
38
0
Total
Democrat
Republican
Independent
THE
COMMONWEALTH
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
Support for Features of Presidential Candidates’
Health Care Reform Proposals
7
“To what extent do you favor or oppose the following features of the presidential
candidates’ health care reform proposals?”
Strongly Favor
Implement market regulations against risk selection
Favor
53
Mandate health insurance with premium subsidies for
low and moderate income
39
Include a public plan option like Medicare in
new group insurance “connector”
Expand Medicaid and SCHIP to include adults at
poverty level or above
83
44
45
34
79
46
33
78
32
Employer pay-or-play mandate
71
39
Set a minimum floor on insurance company
medical-loss ratios
30
32
62
Allow individuals, small businesses, and associations to
buy private insurance across state lines
29
33
62
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
17
11
86
33
52
35
34
45
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Health Care Opinion Leaders Call for Allowing Public8
Plans Like Medicare to Compete with
Private Insurance
“Do you think health care reform should…?
Please select all that apply”
Percent
100
80
65
61
60
37
40
11
20
0
Allow public
Organize and
Replace private
Preserve private
insurance to
regulate private
markets with public
insurance markets
compete with
markets with an
insurance
with reduced
private insurance
insurance connector
regulation
COMMONWEALTH
Source: Shea, K., S. Collins and K. Davis, Health Care Opinion Leaders’ Views on the Presidential Candidates’ Health
Reform Plans, Commonwealth Fund, January 2008.
THE
FUND
Seven in Ten Health Care Opinion Leaders Think the Next
President Should Simultaneously Pursue Universal Coverage
and Improve Quality, Efficiency and Cost Control
9
“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?”
Address quality, efficiency and
costs first and then work on
achieving universal coverage
12%
Universal
coverage first,
and then address
quality, efficiency
and costs
14%
Not sure
3%
Universal
coverage at the
same time as
policies to
improve quality,
efficiency and
costs
70%
Source: Shea, K., S. Collins and K. Davis, Health Care Opinion Leaders’ Views on the Presidential Candidates’ Health
Reform Plans, Commonwealth Fund, January 2008.
THE
COMMONWEALTH
FUND
10
Panel
• Gregg Bloche, Obama for America
• Chris Jennings, Hillary for President
• Tom Miller, John McCain 2008
THE
COMMONWEALTH
FUND