1. 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

2. 2 THE COMMONWEALTH FUND 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? 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 83 87 86

3. 3 THE COMMONWEALTH FUND 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) Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates' Health Reform Proposals, The Commonwealth Fund, January 2008.

4. 4 THE COMMONWEALTH FUND Where Leading Candidates Stand on Health Care Reform Features ClintonEdwardsObamaGiulianiHuckabeeMcCainRomney Most Candidates From Both Parties Agree Expand coverage XXXXXXX Health IT XXXXXXX Transparency XXXXNoXX Malpractice reform XXXXXXX Prevention XXXXXXNo Some Candidates Agree Pay for performance XXXNo X Candidates Differ Universal coverage XXXNo Individual mandate XX Children onlyNo Employer pay or play XXXNo Changes to employer benefit tax exemption XNo XUnclear X Regulation of insurance markets XXXNo Financing Source XXXNo Source: S. R. Collins and J. L. Kriss, Envisioning the Future: The 2008 Presidential Candidates' Health Reform Proposals, The Commonwealth Fund, January 2008.

5. 5 THE COMMONWEALTH FUND Public Support for the Proposal That Employers 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 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. 6 THE COMMONWEALTH FUND 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 80 52 68 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

7. 7 THE COMMONWEALTH FUND Support for Features of Presidential Candidates’ Health Care Reform Proposals “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 52 45

8. 8 THE COMMONWEALTH FUND “Do you think health care reform should…? Please select all that apply” Percent Health Care Opinion Leaders Call for Allowing Public Plans Like Medicare to Compete with 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.

9. 9 THE COMMONWEALTH FUND Seven in Ten Health Care Opinion Leaders Think the Next President Should Simultaneously Pursue Universal Coverage and Improve Quality, 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 sure 3% 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.

10. 10 THE COMMONWEALTH FUND Panel Gregg Bloche, Obama for America Chris Jennings, Hillary for President Tom Miller, John McCain 2008