Health Security
Preliminary Plan Summary
The Health Security plan guarantees comprehensive health
benefits for all American citizens and legal residents,
regardless of health or employment status. Health coverage is
seamless; it continues with no lifetime limits and without
interruption if Americans lose or change jobs, move from one
area of the country to another, become ill or confront a family
crisis.
Every American citizen will receive a Health Security Card that
guarantees comprehensive benefits that can never be taken away.
Fundamental principles underlie health care reform:
- The guarantee of comprehensive benefits for all Americans.
- Effective steps to control rising health care costs for
consumers, business and our nation.
- Improvements in the quality of health care.
- Increased choice for consumers.
- Reductions in paperwork and a simplified system.
- Making everyone responsible for health care.
Americans and their employers are asked to take responsibility
for their health coverage and, in return, they are guaranteed
the security that they will always be covered under a
comprehensive benefit.
The Health Security plan creates incentives for health care
providers to compete on the basis of quality, service and price.
It unleashes the power of the market and puts American
consumers in the driver's seat. Consumers choose from whom and
how they get their care.
The plan empowers each state to set up one or more "health
alliances" that contract with health plans and bargain on behalf
of area consumers and employers. Health plans must meet
national standards for coverage, quality, and service set by the
National Health Board. But each state tailors its approach to
local needs and conditions.
The Health Security plan frees the health care system of much
of the paperwork and regulation, allowing doctors, nurses,
hospitals and other health providers to focus on providing
high-quality care. It cracks down on and abuse, reforms
malpractice law and policy and outlaws insurance practices that
hurt small businesses and imposes the first national standards
for the protection of patient privacy and confidentiality in
medical information and records.
Creating Security
The Health Security plan guarantees every American and legal
resident health coverage that can never be taken away:
- The comprehensive benefits have no lifetime limits on medical
coverage and provides a full range of medically necessary or
appropriate services.
- No health plan may deny enrollment to any applicant because
of health, employment or financial status, nor may it charge
some patients more than others because of age, medical condition
or other factors related to risk.
- All health plans must meet national quality standards and
provide reliable information to consumers so they can choose
their health plans and providers.
- Americans have a broad choice of health plans and providers.
- Elderly and disabled Americans receive outpatient
prescription drug benefits under Medicare for the first time and
expanded access to home and community-based long-term care
services.
- Self-employed workers are able to deduct the full cost of
their health coverage from their federal income taxes.
- Workers older than 55 who retire before they are eligible for
Medicare receive comprehensive coverage for the guaranteed
benefit but continue to pay only the employee share of the
premium.
- New investments and loans help improve the availability and
quality of health care in rural communities and inner-city
neighborhoods.
- School-based and community clinics expand access to care in
areas with inadequate health services.
- Financial incentives and expansion of the National Health
Services Corps attract health professionals to areas with
shortages of doctors and nurses.
Controlling Costs
The Health Security plan cuts the projected growth in health
care costs by increasing competition in health care, reducing
administrative costs and imposing budget discipline. Health
plans compete to provide affordable, quality care:
- Uniform, comprehensive health benefits and reliable
information about the price and performance of health plans
encourage informed choices.
-
Consumers may choose to pay less for lower-cost health plans
or more for higher-cost plans, creating incentives for
cost-conscious decisions.
- Payments to health plans are fixed, providing incentives to
spend resources wisely. Payments are adjusted based on the risk
characteristics of each health plan's participants.
If savings attained through competition and reductions in
administrative burden fail to contain costs, limits on the rate
of growth of insurance premiums provide an emergency brake --
or backstop -- to ensure that premiums remain in line with
inflation.
Health reform also reduces the projected rate of growth in
federal and state spending for Medicare, Medicaid, and other
government programs. Resources conserved from those steps are
applied to other aspects of the health care system, particularly
the expansion of Medicare benefits to include prescription drugs
and for new long-term care services.
The Health Security plan cracks down on providers and
institutions that overcharge or engage in health care fraud. It
sets tough new standards and imposes stiffer penalties that
include:
- New criminal penalties for health care and for the payment
of bribes or gratuities to influence the delivery of health
services and coverage.
- New civil financial penalties against providers who submit
false claims.
- Tighter restrictions to eliminate referral "kickbacks" in the
private sector and new standards that prohibit physicians from
sending their patients to get services at institutions in which
they have financial interests.
- Strong accountability standards that make provider and other
misconduct automatic grounds for exclusion from all health plans.
Expanding Choice
The Health Security plan guarantees consumers a choice of
health plans and enhances the patient-doctor relationship.
- Alliances offer an array of competing health plans from which
individuals and families choose their health coverage, expanding
the range of choice for many Americans.
- Alliances must offer a traditional fee-for-service option in
which every patient can see any physician he or she chooses.
- Consumers -- rather than their employers -- choose their
health plan from among a menu of plans offered by alliances.
- Doctors and other health care providers also have a choice of
health plans and delivery systems in which they may choose to
practice medicine.
- Separate programs increase federal support for long-term care
and improve the quality and reliability of private long-term
care insurance.
Enhancing Quality
The Health Security plan improves the quality of health care.
It creates standards and guidelines for health professionals,
reorienting quality assurance programs to measuring outcomes
rather than regulation, increases the national commitment to
medical research and promotes primary and preventive care.
- Health plans are held accountable for delivering appropriate,
quality care.
- Regular surveys of consumer satisfaction are used to measure
health plans.
- Regular publication of useful and easily understood
information about quality and cost allows consumers to make
informed choices among health plans.
- A special funding mechanism strengthens the role of academic
health centers in research, training and specialized care.
- Increased investment in research advances medical knowledge.
- Changes in Medicare rate schedules and the allocation of
federal funds supporting graduate medical education provide new
incentives for physicians to choose primary care as the focus of
their training.
- Expanded funds for education and new federal action helps
remove artificial barriers to practice that hinder nurses and
other professionals.
- Investments in public health and medical research improve
health protection for all Americans.
Reducing Bureaucracy
The Health Security plan reduces the burden of paperwork and
administration, streamlines regulatory, billing and reporting
requirements and helps reduce confusion.
- A comprehensive benefits package that covers every American
and legal resident reduces confusion for health care providers
and consumers.
- Administrative costs caused by multiple insurance policies
with different benefits and risk selection disappear.
- Standard forms for insurance claims and billing procedures
simplify paperwork and reduce administrative costs.
- Administrative costs for small companies decline as those
firms purchase care through regional health alliances that
benefit from economies of scale.
- The plan simplifies federal regulatory requirements for
Medicare, Medicaid and programs that govern clinical
laboratories.
- The plan requires that health care services covered by
workers' compensation and automobile insurance be delivered
through an individual's health plan reducing duplication and
waste.
- Malpractice reform reduces incentives for the practice of
"defensive medicine," including unnecessary tests and procedures.