Quality, Affordable and Portable Coverage for All

Obama's Plan to Cover Uninsured Americans: Obama 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 plan will have the following features:

1. Guaranteed eligibility.
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.
3. Affordable premiums, co-pays and deductibles.
4. Subsidies.
5. Simplified paperwork and reined in health costs.
6. Easy enrollment.
7. Portability and choice
8. Quality and efficiency.

National Health Insurance Exchange: The Obama 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.

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 employers that meet certain revenue thresholds will be exempt.

• Mandatory Coverage of Children: Obama will require that all children have health care coverage.
• Expansion Of Medicaid and SCHIP: Obama 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 plan builds on these efforts and does not replace what states are doing.

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

• Reducing Costs of Catastrophic Illnesses for Employers and Their Employees: The Obama 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.
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.
3. Require full transparency about quality and costs. Obama 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.

Ensuring Providers Deliver Quality Care:

1. Promote patient safety. Obama will require providers to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.
2. Align incentives for excellence.
3. Comparative effectiveness research. Obama 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.
5. Insurance reform. Obama 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:  Obama 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 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 will prevent companies from abusing their monopoly power through unjustified price increases. His 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. Obama 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.

Mrs. Clinton Attempts to Focus on Quality to Improve Savings & Access to Care -

A reformed high-quality healthcare system must include a strong evidence base so we know what treatments work best, a quality measurement infrastructure based on this evidence to assess the quality of care patients receive from their health care providers, the integration of those quality measures into the delivery of care through health information technology, reimbursement incentives and accountability, and a commitment to placing patients at the center of the system, through increased transparency and greater access to information.

Prepare Providers:

1. Empower Physicians to Improve Quality Through Physician-Driven Certification Programs: In our health care system today, there is tremendous variation in the cost and quality of care from state to state, and even from hospital to hospital in the same town. For example, in Wilkes-Barre, Pennsylvania spine surgery rates are 1.99 per 1,000 Medicare patients, while in Lancaster, they are 5.44 per 1,000. Physician specialty boards, such as the American Board of Internal Medicine, have established Maintenance of Certificate (MOC) programs to promote lifelong learning and help doctors stay up to date on the latest scientific advances and procedures.
2. Recognize Independent Private-Public Quality Trust and Improve Quality Measures: As President, Clinton would direct the Secretary of HHS to invest $125 million in federal funding to recognize a private-public consensus-based organization, such as the National Quality Forum. This proposal will help hold healthcare providers to the highest standards and ensure they have the best information to inform their work with patients.
3. Emphasize Quality in Health Care Workforce, with Focus on Nurses: Provide federal funding to address nursing and nurse faculty shortages and nurse retention issues by establishing innovative training and mentoring programs. To address this problem, Senator Clinton will invest $300 million to:
• Address Nurse and Nurse Faculty Shortages.
• Prioritize the Retention of New Nurses.
• Increase Number of Direct Support Professionals.
• Address Diversity and Cultural Competency in the Healthcare Workforce.
• Link Nursing Education and Quality.

Prepare Patients:

1. Empower Patients with Information on Provider Performance: Informed consumers make decisions that promote the right kind of competition and higher quality and reflect their underlying values and preferences. However, very limited information is available to help patients understand how to choose the best providers, what treatment options are available, what works, and how to stay healthy.

• Develop a Patient-Friendly Quality Database.
• Develop Patient-Friendly Decision Aids to Promote Informed Patient Choice.
• Reduce Health Care DisparitiesAccording to the annual National Healthcare Disparities Report, released by the AHRQ, blacks and Hispanics received poorer quality care than whites on more than 70 percent of the measures. To address these problems, Senator Clinton will:
• Reduce Racial and Ethnic Disparities as Part of the National Quality Agenda.
• Require More Accurate Data Collection.
• Improve Cultural Competency in Clinical Care.
• Prioritize the Development of Medical Homes Designed to Improve Quality for Racial and Ethnic Minorities.

To the Insurers:

1. Incentivize Quality Through Increased Federal Payments: Clinton proposes providing higher payments to healthcare providers that use coordinated care delivered by teams of health professionals to treat the whole patient instead of the patients’ individual illnesses.  Senator Clinton will:
• Financially Reward Excellence in Care: Physicians demonstrating their commitment to quality care through participation in certified Maintenance of Certification programs, and over time through improved patient outcomes, will be recognized as providers of high quality care and will receive higher reimbursement in federal programs, such as Medicare and the Federal Employee Health Benefit Program.
• Develop New Reimbursement Models to Encourage Innovative Care Delivery Systems that Reward Quality -- Not Assembly-Line Care.
• Prohibit Payment of "Never Events" in FEHBP and all Federal Programs: The Bush Administration’s recent decision to refuse Medicare payments for preventable infections, injuries and errors--so-called "never events"--sustained during hospital stays is a positive step.