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ELECTION 2008 SPECIAL Individuals will also be able to purchase separate private insurance

New Jersey than they would for an identical policy one mile across

as an alternative to, or as a supplement to, my plan’s public

the Delaware River, in Pennsylvania. Letting residents buy insurance

component. There is no limit on what services these private plans

across state lines would reduce the uninsured. In addition, policies

will provide for, but the National Health Insurance Exchange will

that are fair for those with chronic illnesses are a must, as well. I

assure that every participating insurer provides a common baseline

will encourage the development of multi-year insurance contracts to

level of benefits that equals those provided by my new public plan.

encourage insurers to design benefits that maintain or enhance the quality of life of those with chronic illnesses, as well as manage their

What, if any, provisions are included in your proposal for changing the health insurance market, and how would they improve the market, especially for people with predictably high medical costs?

costs in a competitive environment.

Senator Obama’s response:

What is the role of health information technology (HIT) under your proposal, and how would the purchase and maintenance of HIT tools be financed?

My plan would ensure that all insurance companies issue fair policies

Senator McCain’s response:

with reasonable premiums to all individuals who apply, regardless

HIT is essential to the success of my proposal. It amazes me a health

of any “pre-existing conditions.” Additionally, my plan will reduce

economy of over two trillion dollars, that epitomizes advanced

administrative costs across the health industry by investing $10 billion

technology, has an underdeveloped HIT infrastructure. Any national

a year over the next five years to adopt standards-based electronic

or global retail chain has invested in and reaped enormous rewards

health information systems, including electronic health records and

from IT investment. What needs to be done to take health care to

billing systems. This transition should save our economy up to $77

the next level? We need to transform the practice of medicine to

billion dollars, which can and should be used to help guarantee that

reward coordination that supports the use of available health IT

health insurance is available to all Americans who seek it.

wherever possible, and that gives patients and providers the data they need to get the best possible value of care delivered. Today,

Additionally, competition between insurance companies within my

much of medical records data is being recorded digitally. My proposal

new National Health Insurance Exchange will lower administration

provides payment reforms for federal health programs and others to

costs. I will also require full transparency about costs to insurance

integrate medical, pharmacy, and service data on as near a real time

companies. Under my plan, health insurers will be required to

basis for a given patient at any location. Physicians and patients need

disclose the percentage of premiums that actually goes to paying for

access to previous drug histories, medical test results, and surgical

patient care, as opposed to administrative costs. Finally, the exchange

notes to know how to proceed on treatment pathway, to ensure

will look to the loss ratio as a guide for deciding if premiums are

the best possible outcome. There will be a role for government in

appropriate.

developing standards and supportive regulation, but the bulk of ongoing investment will remain a private sector activity, as it is in the

My plan will also offer federal reinsurance to employer health plans

remainder of the economy.

to help ensure that unexpected or catastrophic illnesses do not price health insurance out of reach for businesses and their employees.

Senator Obama’s response:

For many small businesses, in particular, having a single employee

I will invest $10 billion per year for five years to transition our health

with catastrophic expenditures can make insurance unaffordable

care system into the electronic age. These funds will be used to move

for all of the workers in the firm. My plan will reimburse employer

the U.S. health care system to broad adoption of standards-based

health plans for a portion of the catastrophic costs they incur above

electronic health information systems, including electronic health

a certain threshold – if they guarantee that such savings will be used

records and will phase in requirements for full implementation of

to reduce the cost of workers’ premiums. Providing reinsurance for

health IT. I will also phase in requirements for full implementation

catastrophic coverage will also reduce premiums.

of health information technology and commit the necessary federal resources to make this change happen. My plan will provide for

Senator McCain’s response:

maximum integration by ensuring that these systems are developed

We live in a highly mobile society. We need health insurance that is

in coordination with providers and frontline workers, including those

portable from job-to-job and job-to-home. Allowing someone to buy

in rural and underserved areas.

insurance across state lines and keep it as they move would not only be more convenient, it could lead to lower premium prices that could reduce the number of uninsured. A family with a husband, wife, and two kids would pay twice as much for a health insurance policy in

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