November 05, 2008

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By Kate Stinchfield
Almost two years of campaign promises are finally over. Now that Barack Obama has been declared the president-elect, it may be time to take a step back and see just what that could mean when it comes to your health. About 66% of voters said that concerns about affordable health care influenced their choice in the 2008 election.

The Commonwealth Fund has compiled a list of health-care reform proposals that Obama announced during his campaign. But given the ongoing financial crisis—not to mention political hurdles—will they actually happen? It's hard to say at this point. But here's a look at what the president-elect has promised.

Requirements for coverage
All children would be required to have health insurance. Obama would consider an individual requirement for adults if substantial numbers of people do not buy coverage that is deemed affordable.

Tax credits/subsidies
Individuals and families who do not qualify for Medicaid or the State Children's Health Insurance Program (SCHIP) but still need assistance to purchase a health plan would receive income-related federal subsidies aimed at keeping health-insurance premiums affordable. Subsidies can be used to buy into the new public plan or purchase a private one. Small businesses would receive a Small Business Health Tax Credit, a refundable tax credit of up to 50% of premiums, which could be used to buy coverage for their employees.

Obama would finance the new system by allowing the expiration of tax cuts for households with incomes of $250,000 and above. He would also use revenue from employer contributions.

Prescription drugs
The proposal calls for the federal government to negotiate directly with pharmaceutical companies under the Medicare prescription drug benefit. U.S. residents would be allowed to purchase medication from Canada and other developing countries, if the drugs are safe and the prices are lower. Obama's strategy would increase use of generic drugs in the new public plan, Medicare, Medicaid, and the Federal Employees Health Benefits Program (FEHBP), and prohibit large drug companies from keeping generic drugs out of the marketplace.

Obama would strengthen antitrust laws to prevent insurers from overcharging physicians for malpractice insurance. He also aims to identify physician errors to improve patient safety, strengthen the doctor-patient relationship, and reduce the need for malpractice suits.

Patient safety
In addition to the above, the plan would support hospitals and physician practices in their efforts to prevent medical errors.

Comparative effectiveness/quality improvement
An independent institute would be established to guide reviews and research on the comparative effectiveness of various treatments. Hospitals and other providers participating in the new public plan would be required to collect and report data to ensure that standards for quality, health information technology, and administration are being met. Funding for biomedical research and research on the causes and treatment of autism would be strengthened.

Insurance market regulations
All insurers, including those not selling products through the exchange, would have to issue all applications a policy and charge premiums that do not depend on health status. Insurers would be required to pay out a reasonable share of their premiums for patient care, relative to profits and administrative costs.

States would not replace their existing health-care reform efforts, provided they meet the minimum standards of care of the national plan.

Obama's blueprint would require hospitals and health plans to collect, analyze, and report health-care quality disparities and hold them accountable for differences. It would diversify the workforce, implement and fund evidence-based programs such as patient navigator programs to reduce disparities, and expand the capacity of safety-net institutions.

Medicare private plans
The new program would eliminate extra subsidies to private Medicare Advantage plans and pay them the same amount that it cost to treat the same patients under regular Medicare.

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