2008 presidential candidate health plans
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2008 Presidential Candidate Health Plans Individual Insurance Market with taxed benefits, tax credits and minimal state rules (regulations) v. Group Insurance-public/private mix with premium subsidies and consumer protections (regulations)

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2008 presidential candidate health plans l.jpg

2008 Presidential Candidate Health Plans

Individual Insurance Market

with taxed benefits, tax credits and minimal state rules (regulations)


Group Insurance-public/private mix

with premium subsidies and consumer protections (regulations)

Health reform critics health affairs september 16 2008 l.jpg
Health reform critics(Health Affairs September 16, 2008)

  • McCain Plan

    “Achieving Senator McCain’s vision would radically transform the U.S. health insurance system…for the nearly 160 million Americans who now receive health insurance through their employers. We estimate that twenty million…would lose current coverage…offset [initially] by an increase in coverage in the nongroup market. The decline of job-based coverage would force millions of Americans into the weakest segment of the private insurance system—the nongroup market—where cost sharing is high and covered services are limited. Senator McCain’s proposal to deregulate this market would mean that people in it would lost protections they now have. These changes would diminish the security of coverage for most Americans, especially those who are not in perfect health.”

  • Obama Plan

    “The health reform plan put forth by Senator Obama focuses on expanding insurance coverage and provides new subsidies to individuals, small businesses and businesses experiencing catastrophic expenses. It greatly increases the federal regulation of private insurance but does not address the core economic incentives that drive health care spending…Heavy regulation coupled with a fallback national Health Plan and a play-or- pay financing choice also raise questions about the future of the employer insurance market.”

Criteria for 2008 candidate comparison access cost affordability and quality mccain obama l.jpg
Criteria for 2008 candidate comparison: Access, Cost/Affordability and Quality (McCain/Obama)

  • How much progress toward universal coverage? (-/+)

  • Will system costs (prices) come down? (0/0)

  • How much will people pay for healthcare coverage?


  • Will quality (comprehensiveness and excellence) improve? (-/+)

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McCain: Key Features Cost/Affordability and Quality

  • Weaken employer role in health insurance; encourage people to purchase individual coverage in the private market

  • Remove tax exclusion for employer-sponsored health benefits (i.e. tax employees health benefits as income) and replace with a $2500/5000 tax credit

  • Deregulate non-group insurance by permitting purchase across state lines

  • Strategies for efficiency

    (disease management, IT, liability reform, pricing transparency)

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Obama: Key Features Cost/Affordability and Quality

  • Expand insurance coverage and increase regulation of private insurance plans – 5 ways

  • 1. National Insurance Exchange

    (individuals can choose plans, minimum benefit package, coverage guarantee, community rated)

  • 2. National Health Plan

    (small employers and those with no other access—equal terms for all, subsidies for low income)

  • 3. Reinsurance for Insurance Providers

  • 4. Insurance mandate for large employers (pay or play)

  • 5. Insurance mandate for children (parents’ coverage up to age 25, expand SCHIP

  • Strategies to improve health status and quality of medical care

    (chronic disease management, prevention, evidence basis, IT)

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Key Differences Cost/Affordability and Quality

Universal coverage l.jpg

Obama: Cost/Affordability and Quality

Increased coverage immediately

Estimates for 2018:

33 Million uninsured


Little change; Decreased coverage over time

Estimate for 2018:

65 Million uninsured

Universal coverage

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McCain Cost/Affordability and Quality

$ 1.31 trillion


$ 1.63 trillion

Plan Cost Estimates: 2009-2018

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Obama: Cost/Affordability and Quality

Public funding:


(subsidies and SCHIP expansion

Overall healthcare costs

Little change--

some decrease possible due to increased coverage and efficiencies

Out of pocket:

Employer or self with public subsidy


Public funding:

No change initially

(taxes on benefits=tax credits)

decrease over time

Overall healthcare costs

Possible increases in insurance costs and actual costs of care due to profit incentives and lack of regulation

Out of pocket:

Employer or self with tax credit of 2500/5000.

Decrease in Costs

Quality l.jpg

Obama Cost/Affordability and Quality

Mandated benefits and increased coverage should increase continuity and comprehensiveness of care.


Erosion in scope of benefits and lack of continuity of care for uninsured should decrease quality. State laws requiring types of coverage will be weakened.


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Reform Principles Cost/Affordability and Quality

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Common public complaints Cost/Affordability and Quality

  • Rate increases for those with health conditions

    McCain does not address

    Obama will not allow

  • Denial of coverage

    McCain does not address

    Obama will not allow

  • Gaps in coverage

    McCain does not address

    Obama promises comprehensive coverage

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Resources Cost/Affordability and Quality

  • www.commonwealthfund.org

    The Commonwealth Fund Foundation

  • www.health08.org

    Henry J. Kaiser Family Foundation

  • www.healthaffairs.org

    The health policy journal, Health Affairs