Achieve Universal Health Insurance Coverage
Where the Candidates Stand
Universal health care insurance is necessary to ensure that everyone within the United States has access to needed health care services of high quality. ACP recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage, recognizing that each pathway has certain advantages and disadvantages, as described below, that need to be considered by the public and policymaker in deciding which is best for the United States:
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Pluralistic systems, which involve government entities as well as multiple for-profit and/or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs. Pluralistic financing models must provide (1) a legal guarantee that all individuals have access to coverage and (2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage. (See ACP Proposal for Achieving Affordable Coverage for All
as an example of how a pluralistic system can achieve universal coverage). -
Single payer financing models, in which one governmental entity is the sole third party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private insurance, lower per capita health car expenditures, high levels of consumer/patient satisfaction and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems. Such systems typically rely on global budgets and price negotiations to help restrain expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individual’s freedom to make their own health care choices.
Access to affordable coverage, whether provided through a single-payer or pluralistic financing model, should include coverage for a core package of benefits, including preventive services, primary care services, including but not limited to chronic illness management, and protection from catastrophic health care expenses.
Until there is a political consensus for achieving universal coverage at a federal level, Congress should encourage state innovation and provide dedicated funds to support state-based programs with an explicit goal of covering all uninsured persons within the state.
From ACP’s Position Paper, Achieving a High Performance Health Care System with Universal Access .
Where the Candidates Stand
Senator Hillary Clinton (D-NY)
ACP Key Benchmarks for Reform
Achieve universal health insurance coverage. Ensure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status.
The Candidate’s Stand
Clinton’s proposal seeks to secure universal health insurance coverage by the end of her Presidency. Her proposal for securing such coverage includes strengthening Medicaid and SCHIP; establishing income-dependent, refundable tax credits and subsidizing the purchase of health insurance; creating a new small business tax credit to enable small businesses to offer coverage to their employees; and launching a retiree health legacy initiative.
Clinton’s proposal would build upon the existing pluralistic system. It does not include a single payer option.
Clinton’s proposal calls for both individual and employer mandates for coverage. Once health insurance is made affordable and accessible, individuals will be responsible for obtaining and maintaining coverage. Large employers will be required to either provide coverage for their employees or contribute to the cost of coverage. Small employers will be granted a tax credit to continue or commence offering coverage.
Clinton seeks to improve access for the uninsured by proposing changes in the laws governing the marketing, rating and renewal practices of insurers. Her proposal seeks to eliminate unfair discrimination in insurance coverage by prohibiting insurers from denying coverage, refusing to renew coverage and unfairly pricing individuals out of the insurance market.
For more information visit the Clinton website.
Senator John McCain (R-AZ)
ACP Key Benchmarks for Reform
Achieve universal health insurance coverage. Ensure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status.
The Candidate’s Stand
McCain’s proposal places greater emphasis on containing health care costs rather than on expanding access to health insurance coverage to the uninsured. His proposal is not designed nor intended to achieve universal coverage. As a means of expanding access to coverage, McCain proposes eliminating the tax treatment of employer-sponsored health insurance; providing a tax credit incentive to all individuals and families for the purchase of coverage; allowing the purchase of portable, multi-year health coverage; and promoting competition amongst insurers.
McCain’s proposal would build upon the existing pluralistic system. It does not include a single payer option.
McCain does not support mandates for health insurance coverage, care or costs.
McCain supports making health insurance portable across jobs, available to purchase on a multi-year basis and able to automatically bridge gap between retirement and Medicare eligibility.
For more information visit the McCain website.
Senator Barack Obama (D-IL)
ACP Key Benchmarks for Reform
Achieve universal health insurance coverage. Ensure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status.
The Candidate’s Stand
Obama’s proposal seeks to achieve universal, portable coverage by the end of his first Presidential term. His proposal for achieving such coverage includes establishing a National Health Insurance Exchange, enabling individuals and small businesses to purchase affordable private coverage similar to that offered through the FEHBP; providing federal subsidies to those in need; expanding Medicaid and SCHIP eligibility; creating a new public health insurance plan based on the FEHBP with guaranteed eligibility; and promoting state experimentation with health coverage expansion.
Obama’s proposal would build upon the existing pluralistic system. It does not include a single payer option.
Obama proposes a coverage mandate for all children and requires all employers that do not provide coverage to contribute a portion of their payroll to a national coverage program.
Obama’s proposal requires insurers to accept all applicants for coverage and prohibits charging different premiums based on pre-existing conditions.
For more information visit the Obama website.
Policy Highlights
Establishing Federal Guidelines Protecting Against Genetic Discrimination - March 2008
Achieving a High Performance Health Care System with Universal Access: What the USA Can Learn from Other Countries, at www.annals.org. December, 2007
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