The presidential candidates have responded to Americans' deep-seated concerns about the US health system with 2 very different health reform proposals.
Senator McCain would provide refundable tax credits for the purchase of health insurance coverage – $2500 for individuals and $5000 for families. He would also count employer contributions to health insurance premiums as taxable income for families. As a result, some people would pay less than they now pay; some would pay more.[1]
Under Senator McCain's plan, roughly 20 million would lose employer coverage and 21 million would buy individual coverage, for a net reduction in the uninsured of 1 million.[2] Over time, the number of uninsured would grow.
By contrast, Senator Obama would provide income-related premium assistance to lower- and middle-income families – although the exact amounts are not specified – and expand coverage under Medicaid and the State Children's Health Insurance Plan. His plan would cut the number of uninsured by 18 million in the first year, and over time hold the number of uninsured to 33 million rather than rising to a projected 67 million in 2018.
Senator McCain would effectively deregulate the health insurance market by permitting individuals to purchase coverage in any state. His philosophy is that consumers making cost-conscious choices would buy policies with leaner benefits, but skimpier plans are not the answer. Low- and even middle-income families are already experiencing difficulty paying medical bills, and accumulated medical debt is rising.[3]
Senator Obama has a different strategy for making coverage affordable. He would offer a public plan as well as private insurance plans through a national health insurance exchange and set rules for the sale of private insurance, such as requiring private insurance to cover healthy and sick enrollees on the same basis. Private plan premiums would be required to go mostly to medical care, not profits.
My hope is that, post election, the focus will turn to building on the areas of agreement, and work from there to achieve the health system reform that the country needs so desperately.[4]
That's my opinion. I'm Karen Davis, from The Commonwealth Fund.
Footnotes
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References
- 1.Collins SR, Nicholson JL, Rustagi SD, Davis K. The 2008 presidential candidates' health reform proposals: choices for America. The Commonwealth Fund website. October 2, 2008. Available at: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=707948 Accessed October 1, 2008.
- 2.Buchmueller T, Glied SA, Royalty A, Swartz K. Cost and coverage implications of the McCain plan to restructure health insurance. Health Aff (Millwood) 2008;27:472–481. doi: 10.1377/hlthaff.27.6.w472. Available at: http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.6.w472 Accessed October 1, 2008. [DOI] [PubMed] [Google Scholar]
- 3.Schoen C, Collins SR, Kriss JL, Doty MM. How many are underinsured? Trends among U.S. adults, 2003 and 2007. doi: 10.1377/hlthaff.27.4.w298. The Commonwealth Fund website. June 10, 2008. Available at: http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=688615 Accessed October 1, 2008. [DOI] [PubMed]
- 4.Davis K. The presidential candidates' health reform plans: important choices for the nation. The Commonwealth Fund website. September 16, 2008. Available at: http://www.commonwealthfund.org/aboutus/aboutus_show.htm?doc_id=705935 Accessed October 1, 2008. [PMC free article] [PubMed]
