How Do Bush/Kerry Proposals
Stack Up Against ACPM's
"Health Care for All" Position Statement?

This is a comparative review of each presidential candidate’s health care proposals with ACPM’s Health Care for All position statement.  Listed below are the five General Principles as defined within ACPM’s position statement, and each principle is followed by a brief policy analysis. 

1. Assure, for all U.S. residents, access to and payment for a federally defined and nationally implemented package of essential health services recommended through a national guidelines development process, with no denial of coverage and minimum personal co-payment.

Though the Bush and Kerry plans are fundamentally different, both fall short of ensuring that all U.S. residents have access to health care.  The main differences lie in the number of uninsured that will be covered through each plan, the amount that it will cost to provide additional coverage, and each candidates’ proposals on how he will extend that coverage to the millions of uninsured Americans. 

Kerry seeks to cover 26.7 million uninsured at a cost of $653 billion.  He plans on accomplishing this by allowing individuals and small businesses to enroll in a FEHBP-type program, covering all uninsured children, and mandating full financial responsibility of CHIP programs to the states while providing full federal reimbursement for Medicaid.  He also hopes to create a federal reinsurance pool to cover catastrophic insurance claims for individuals and businesses.

Bush proposes expanding individual coverage through private insurance by making it more affordable to purchase coverage through tax incentives and credits.  Health care analysts estimate that this proposal will cover anywhere from 2.1 to 4.0 million uninsured.  The Bush plan also creates 1,200 Community Health Centers to provide primary care to 6.1 million uninsured.
 

2. Allow states, employers, and individuals the flexibility of supplementing the package of essential health services.

The Bush and Kerry plans offer no firm statement on the flexibility to supplement their health coverage, but it appears as though they permit such supplemental coverage.  Bush relies on a private insurance model to provide additional coverage to the uninsured, and such a system has always allowed the purchase of supplemental coverage.  The Kerry plan does not eliminate the private insurance model, and while it is supplemented by public insurance, the acceptance of private insurance assures that individuals can most likely purchase supplemental coverage. 
 

3. Build, where possible, on the current strengths of the American system to deliver high quality health care and prevention services, with minimal administrative and underwriting costs.

Despite lacking a clear definition of the current strengths of the health care system, both proposals appear to continue high-quality care and expand prevention services.  Bush and Kerry seek to reduce administrative and underwriting costs through increased reliance on electronic standards to minimize overhead costs and the adoption of technology to streamline patient care. 

4. Use economic, behavior modification, and disease management tools to minimize both the over-utilization of marginally beneficial and the underutilization of demonstrably beneficial health care services.

The Bush and Kerry plans both adopt economic, behavioral modification, and disease management tools to more efficiently utilize health resources.  Bush and Kerry advocate minimizing health care costs by increasing disease prevention and health promotion programs (although both lack specifics).  Kerry’s economic management tools include capping individual premiums to 6-12% of income for those enrolled in the FEHBP-type plan.  He has also pledged to create a reinsurance pool where the federal government will provide reimbursement for 75% of catastrophic coverage costs.  He projects that this will reduce insurance costs by 10%.  By contrast, Bush is encouraging greater enrollment in his Health Savings Accounts program which he states will reduce unnecessary physician visits by making patients more aware of their health insurance costs.  [It is important to note that the ACPM Position Statement specifies that “none of the economic tools will unfairly inhibit access to essential health services…”  There is disagreement among critics and proponents of HSAs as to whether they inhibit access to crucial services by making patients determine the severity of their condition or simply eliminate unneeded (and costly) physician visits.  Critics of HSAs might validly argue that HSAs undermine the principle of providing uninhibited access to necessary services.  Proponents counter that preventive services are covered by HSAs and that beneficiaries are often encouraged through financial incentives to utilize them.]
 

5. Establish state and national quality assurance and surveillance systems, which include physicians as well as financial managers, to monitor and evaluate access to care, quality of care, and medical outcomes.

Both candidates’ proposals address the improvement of quality assurance and surveillance systems, but Kerry’s recommendations appear to be slightly more comprehensive.  Kerry urges improving care through a “quality bonus” which will set benchmarks for providers to receive financial incentives to improve quality.  He pledges to make errors more transparent in order to prevent their reoccurrence and minimize patient injuries.  Lastly, he will require transparency rules for pharmacy benefit managers to improve patient access to prescription drugs. 

Bush advocates for a Patient’s Bill of Rights to ensure that physicians, rather than insurance companies, determine medical decisions.  He proposes to make genetic discrimination illegal, strengthen medical privacy laws, and also provide better information on treatment and quality to the public.  As with Kerry, he similarly agrees that information on medical errors need to be shared in order to improve quality of care.  In conclusion, Kerry’s plan for a “quality bonus” seems slightly more aligned with the ACPM principle of quality assurance as it appears more extensive, but it also lacks specifics in implementation, benchmarks, and incentives.