The Presidential Campaign Health Reform Proposals

This is an excerpt from a GMHC report: Prescriptions for Reform: A Comparison of the Bush and Kerry Health Care Access Proposals and Their Impact on People With HIV/AIDS (PDF).

The success of any government's health care system depends on whether health care is affordable, accessible, promotes quality, offers maximum coverage for its citizens, supports innovation, and provides access to the newest technology. It is by these standards that Americans, especially people living with HIV/AIDS, should judge the 2004 candidate's campaign proposals. The following outlines the plans offered by the President Bush and Senator Kerry.

Strengthening Public Programs and Maintaining AIDS Funding

President Bush

  • Implements the Medicare Modernization Act (MMA), to be fully rolled out in 2006, which will:

    • Add a prescription drug benefit to Medicare with safeguards against high out-of-pocket costs for low-income individuals;

    • Provide Medicare beneficiaries with the "choice of individual health plan" as well as a "choice of doctor or hospital" by increasing funding and flexibility for the Medicare managed care program;

    • Provide coverage of disease prevention (cancer screenings, diabetes, osteoporosis).

  • Pursues capped federal allotments for Medicaid programs on a state-by-state basis through a Medicaid "reform" proposal as well as waivers of existing federal Medicaid law.

  • Temporarily extends the Medicaid transition benefit for families moving from welfare to work.

  • Creates a new Medicaid option to allow people with disabilities to have greater flexibility over directing their care in the home and community (New Freedom Initiative).

  • Supports modest increases in funding for ADAP, including $20 million to reduce waiting lists in 2004.

  • As part of Ryan White Care Act (RWCA) reauthorization, provides Health and Human Services (HHS) with more discretion over RWCA funds and the authority to determine whether groups are making "good use" of their monies, as well as expand the number of religious groups funded to help people with HIV/AIDS.

  • Commits to doubling the number of community health centers by 2006, so that they can serve an additional 6.1 million patients.

Senator Kerry

  • Addresses perceived problems in the new Medicare law (e.g., aims to reduce the number of retirees losing coverage due to the law, reduce HMO overpayment).

  • Expands Medicaid by having the federal government pay for the coverage of all 20 million children on Medicaid if states:

    • Expand Children's Health Insurance Program (CHIP) coverage up to 300% of federal poverty level (FPL) (enrollment bonuses are included);

    • Expand family coverage to 200% FPL (states will get enhanced matching rate);

    • Ensure childless couples and single adults have coverage at or below the poverty level.

  • Promotes automatic CHIP enrollment at school, continuous 12 months of eligibility, facilitated enrollment, dropping the five year wait for legal immigrant pregnant women and children, and allowing disabled children to keep their insurance if parents return to work.

  • Opposes block granting of Medicaid program, and provides $25 billion for state fiscal relief in first two years of term.

  • Supports the Early Treatment for HIV Act (ETHA), which would give states the option to expand Medicaid to cover HIV-positive individuals who are not yet disabled.

  • Increases RWCA to end ADAP waiting lists (no dollar amount provided).

  • Supports development of federal guidelines that integrate HIV prevention into primary care in Medicaid.

  • Supports community health centers (no specific commitment).

Expanding Health Insurance Access and Making Coverage More Affordable

President Bush

  • Offers new health care tax credits for use in the individual market or in state-created pooled purchasing groups:

    • Single adults will be eligible for up to $1000 a year if income is below $15,000; the credit phases out by $30,000;

    • Families with two or more children could receive up to $3,000 a year in tax credits if income is below $25,000; the credit phases out by $60,000.

  • Promotes high-deductible individual market insurance linked to Health Savings Accounts (created by the MMA, accounts that allow for virtually tax-free savings for out-of-pocket costs); allows premiums to be tax deductible.

  • Supports Association Health Plans, which would allow small employers to pool together to purchase health insurance for employees. Such coverage would be exempt from state regulation.

  • Allows premium payments for long-term care insurance to be fully tax deductible.

  • Supports tax exemptions for people who take time to care for spouses or parents with long-term care needs.

Senator Kerry

  • Creates a new pool modeled on the Federal Employees Health Benefits Program (FEHBP) for small and large businesses, individuals, and families that need to purchase health insurance. For the uninsured, tax credits will be available for those who purchase the new group option for premiums exceeding 6% and up to 12%, based on income. In addition:

    • Small businesses would be eligible for tax credits up to 50% of premiums;

    • Americans ages 55-64 without access to employer-based insurance may receive a 25% tax credit;

    • Low-income unemployed would be eligible for refundable tax credits up to 75% for COBRA or the new group option.

  • Creates a premium rebate pool that would reimburse employee health plans and the new pool for 75% of catastrophic costs above a certain threshold ($35,000 in 2006, $50,000 in 2013) to reduce premiums and make them more predictable. To qualify for this reinsurance, employers would have to pass along savings to workers, cover most workers, and use disease management. Senator Kerry claims this would save approximately 10% of premium costs, or up to $1,000 off a family plan.

  • Supports Executive Order to ensure participants in the new pool will be guaranteed the right to family health benefits for their domestic partners.

Reducing Health Care Costs

President Bush

  • Reforms the country's medical malpractice system by:

    • Allowing unlimited compensation for economic losses;

    • Capping non-economic damages at $250,000;

    • Limiting punitive damages to "reasonable" amounts;

    • Prohibiting payments from being made in a single lump sum;

    • Reducing amount that doctors must pay if plaintiff has received payments elsewhere;

    • Requiring defendants pay judgments in proportion to fault.

  • Reduces Medicaid costs through an anti-fraud policy.

  • Expands the use of information technology which could reduce administrative costs (see below).

Senator Kerry

  • Reforms the country's medical malpractice system by:

    • Opposing capped damages;

    • Stopping bad claims unless reasonable;

    • Supporting mandatory sanctions for claims that are presented for improper purposes;

    • Requiring states to have non-binding mediation;

    • Opposing award of punitive damages in medical liability unless proof of intentional misconduct.

  • Eliminates loopholes that pharmaceutical companies use to keep generic drugs off the market.

  • Requires pharmacy benefit managers that do business with the federal government to be transparent and show savings accrued from industry and bulk purchasing.

  • Helps states use Medicaid's ability to negotiate drug prices to cover other populations.

  • Provides incentives to states to implement more efficient contracting to leverage better prices.

  • Promotes disease management by linking it to new financing increases (see above).

  • Expands the use of information technology, which could reduce administrative costs (see below).

  • Reduces the amount of uncompensated care in the system by expanding coverage.

Improving Quality and Promoting a Strong Health Care System

President Bush

  • Supports legislation that would implement a Patient's Bill of Rights with a provision that would limit a patient's right to sue.

  • Promotes "consumer-driven health care" in which consumers have access to better information about medical treatments and health providers, including the quality of nursing homes.

  • Encourages the use of electronic medical records with strong privacy protections. Sets goal of having electronic medical records for most Americans within 10 years.

  • Calls for an increase in National Institutes of Health funding that would "improve the prevention, detection and treatment of diseases;" opposes stem cell research except under tightly-constrained circumstances.

  • Increases funding for bioterror preparedness efforts.

  • Supports legislation that allows medical professionals to work together to share information with the anticipation of fewer medical errors.

Senator Kerry

  • Supports legislation that would implement a Patient's Bill of Rights, as well as mental health parity.

  • Provides financial incentives, like a "Technology Bonus," for providers to institute electronic medical records, patient registries, and computerized prescribing systems.

  • Supports efforts to reduce ethnic and racial disparities in health care.

  • Requires private insurers to be using electronic medical record technology if contracting with Medicare, Medicaid and for the Federal Employee Health Benefits Program by 2008.

  • Supports stem cell research.

  • Creates "Quality Bonus" that moves toward a "pay-for-performance" system to improve health outcomes and reduce errors.

Cost of Plans and Numbers of Newly Insured

President Bush

According to the U.S. Office of Management and Budget and the Treasury Department, President Bush's health care plan costs $104.3 billion over 10 years including the long-term care policies. The Administration states these initiatives will cover 4 million to 6 million Americans.

According to Ken Thorpe of Emory University, President Bush's plan costs $90.5 billion over 10 years, excluding the long-term care provisions and Medicaid savings, and covers 2.4 million Americans; however, the number of covered Americans will decrease because the dollar value of the refundable credits decline over time.

Senator Kerry

According to Thorpe, Senator Kerry's health plan costs $653 billion over 10 years and would increase the number of insured Americans by 27 million. Senator Kerry has indicated that his plan would be financed by repealing the tax cut that President Bush implemented in 2001 for families with incomes above $200,000.

Issues/PositionsHIV/AIDS CommunityPresident BushSenator Kerry
Supports capped allotments/capped federal funding for MedicaidNoYesNo
Supports Medicaid state fiscal reliefYesNoYes, proposes $25 billion in first 2 years in office
Supports Early Treatment for HIV ActYesUnclearYes
Supports implementation of Medicare Modernization Act as passed by CongressPart D formularies must include all HIV medications; must contain other provisions that will help people with HIV/AIDSYesYes, with changes to ensure low drug prices for Medicare, prevent retirees from losing coverage, and reduce HMO overpayment
Supports permitting the federal government to negotiate drug prices for MedicareYesNoYes
Supports reimportation and efforts to reduce cost of prescription drugs by closing loopholes when generics go to marketYesNoYes
Supports increased funding for the Ryan White CARE ActYes, CARE Act needs $3.1 billion to deliver services to all people with HIV/AIDS in need of careAppropriated $2 billion in 2004. Budget calls for $35 million increase in FY 05, which includes a $20 million emergency ADAP allocationYes, supports funding to "end ADAP waiting lists and provide an appropriate standard of care;" funding level not specified
Supports tax credits for individualsNot a priorityYesYes
Supports Health Savings AccountsNoYesNo
Supports Association Health PlansNoYesNo
Supports new Federal Employees Health Benefits Program poolYesNoYes
Supports premium rebate poolUnclearNoYes
Cost of plansN/A$90 billion - $105 billion over 10 years$653 billion over 10 years
Number of newly insured AmericansN/A2 million to 6 million27 million