This side-by-side comparison of the candidates' positions on health care was prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc. and is based on information appearing on the candidates' websites as supplemented by information from candidate speeches, the campaign debates and news reports. The sources of information are identified for each candidate's summary (with links to the Internet). The comparison highlights information on the candidates' positions related to access to health care coverage, cost containment, improving the quality of care and financing. Information will be updated regularly as the campaign unfolds.
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Rudy Giuliani |
Hillary Clinton |
Christopher Dodd |
| Party Affiliation |
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| Stated goal |
- Transform the way health insurance coverage is provided by using free-market incentives that will also reduce costs and improve quality.
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- Affordable and high-quality universal coverage through a mix of private and public insurance.
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- Affordable and high-quality universal coverage through mix of private and expanded public insurance.
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| Date plan announced |
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- May 24, 2007 for cost, August 23, 2007 for quality, and September 17, 2007 for coverage
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| Overall approach to expanding access to coverage |
- Provide individuals without employer-based coverage a health insurance tax deduction to subsidize their health insurance premiums and provide lower-income families a tax credit to help subsidize their premiums. Tax changes are intended to shift millions from employer-based to individual insurance.
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- Every American required to have coverage, with income-related tax subsidies available to make coverage affordable. Private and public plan options would be available to individuals through a new Health Choices Menu operated through the Federal Employee Health Benefits Program (FEHBP). Coverage through employers and public programs like Medicare continues.
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- Requires individuals to obtain health coverage and requires employers to offer coverage or help finance coverage for employees. Creates a new program, Universal HealthMart that would be based on and parallel to FEHBP. The federal government would subsidize premiums for individual and businesses unable to afford them. People under 100% of poverty would be eligible to enroll in Medicaid. Medicare would remain as it is today.
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| A. Requirement to obtain or offer coverage |
- No provision. Opposes government mandated insurance coverage.
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- Individuals must have health insurance coverage.
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- Require employers that elect not to offer coverage to pay a defined contribution into HealthMart. These funds would be used to help workers pay for insurance.
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| B. Expansion of public programs |
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- Medicaid and SCHIP safety net strengthened “for the most vulnerable populations” to plug gaps, such as lack of coverage for poor, childless adults.
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- Medicare would remain as is.
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| C. Premium subsidies to individuals |
- Provide a refundable tax credit to low-income individuals that could be coupled with Medicaid coverage and employer contributions.
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- The value of the credit would be set to ensure that premiums could not exceed a fixed percentage of family income, while maintaining price consciousness among consumers.
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- Make federal premium subsidies available to families obtaining coverage through HealthMart based on their ability to pay.
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| D. Premium subsidies to employers |
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- A “retiree health legacy initiative” would provide qualifying public and private sector employers offering retiree health plans with a tax credit to offset catastrophic health expenditures, “as long as savings are dedicated to workers and competitiveness.”
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- Make federal premium subsidies available to businesses obtaining coverage through HealthMart based on their ability to pay.
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| E. Tax changes related to health insurance |
- Simplify HSA regulations.
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- Employer-provided health premiums would continue to be excluded from income taxes except for “the high-end portion of very generous plans for those making over $250,000.”
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| F. Creation of insurance pooling mechanisms |
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- Employers could buy coverage through the new Health Choices Menu on behalf of workers or early retirees.
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- HealthMart would offer a variety of comprehensive private plans and entitle every American to same benefits and types of plans as Members of Congress.
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| G. Changes to private insurance |
- Permit individuals to purchase insurance across state lines.
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- Require all insurers that participate in federal programs to cover preventive services based on recommendations of US Prevention Services Task Force and promote chronic disease management.
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- HealthMart would offer coverage through private insurers that are willing to agree to specific standards and offer comprehensive benefit packages, including preventive health screenings for children.
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| H. State flexibility |
- Provide states with block grants to encourage innovation, reduce health costs, enroll the eligible uninsured in public plans, and address adverse selection issues.
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- State option to band together to offer same type of choices in a region of the country as Health Choices Menu.
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| Cost containment |
- Supports medical liability reform.
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- Proposes a 7-Step Strategy to Reduce Health Costs:
- A national prevention initiative;
- A “paperless” health information technology system;
- Chronic care coordination to improve outcomes;
- Elimination of insurance discrimination to help reduce administrative costs;
- An independent “Best Practices Institute” to help consumers and other purchasers and plans make the right care choices;
- “Smart purchasing” initiatives to constrain prescription drug and managed care expenditures (permit the Secretary to negotiate prices for Medicare prescription drugs, limit direct-to-consumer advertising of prescription drugs and change patent laws to increase the availability of generic drugs; and reduce payments to Medicare Advantage plans to create more level reimbursement with traditional Medicare); and
- Linking medical error disclosure with physician liability protection.
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- HealthMart would leverage its size and buying clout to negotiate premiums and to encourage adoption of a single claims processing system.
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| Improving quality/health system performance |
- Proposes that “health insurance should be redefined to cover wellness as well as sickness.” Promote healthy lifestyles and tie federal Medicaid payments to a state’s success in promoting preventive care and tracking obesity in children.
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- Prohibit payment of “never events” (such as preventable infections) in FEHBP and other federal programs.
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- Provide awards and incentives to encourage smoking cessation, weight loss and exercise.
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| Other investments |
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- Support initiatives to reduce health care disparities, including funding for more accurate data collection, development of quality measures targeted at reducing racial and ethnic disparities, and prioritizing the development of medical homes designed to improve quality for minorities.
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- Expand public health and the safety net to increase outreach and care provided at the community level.
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| Financing |
- Not specified. Says that health care reform can be achieved “through tax cuts, not tax hikes.”
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- Campaign estimates cost to be $110 billion a year when fully phased in. $35 billion to be financed by savings from quality and modernization initiatives. Additional $21 billion in savings from Medicare private plans, recapturing Medicare and Medicaid payments to hospitals for the uninsured, and constraining prescription drug costs. Also $54 billion in revenue from limiting the tax exclusion for employer-paid health insurance and discontinuing tax cuts for those with incomes over $250,000.
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- Asserts that a new tax would not be required to finance universal coverage. The Universal HealthMart would be financed primarily by a combination of employer and individual/family premiums, recapturing existing uncompensated care subsidies, and from contributions and savings realized through “eliminating the existing inefficiencies in the system.” Additional revenues to finance transition costs would come from “other revenue streams” including those that result from ending the war in Iraq.
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