Obama health care proposal

What is the health information policy of the Obama health care proposal?
Overall assessment
• Greatly increase health insurance coverage but would still leave about 6% of the non-elderly population uninsured, compared to 17% today.
• Substantially increase access to affordable and adequate coverage for those with the highest health care needs, including those with chronic illnesses, by spreading health care risk broadly;
• Significantly increase the affordability of care for low-income individuals; and
• Reduced the growth in health spending through a broad array of strategies.
In short, Obama’s proposal contains the basic components necessary for effectively addressing the most important shortcomings of the current health care system, that is, limited coverage, inadequate risk pooling, and high-cost growth.
Coverage
• Extending eligibility for Medicaid and SCHIP (State Children’s Health Insurance Program)
• Providing income-related subsidies for coverage in the NHIE (National Health Insurance Exchange), and
• Offering a guaranteed source of purchasing insurance coverage, even to those in poor health.
Risk Pooling
• Prohibiting insurance companies from using health status to determine price coverage,
• Making comprehensive benefits available to all through the NHIE, and
• Using broad-based sources of revenue to finance health insurance subsidies, thus guaranteeing that all taxpayers, not just those voluntarily deciding to purchase coverage, share in the costs of providing medical care.
Cost Containment
• Spending $50 billion over several years to accelerate the adoption of electronic medical records and other efficient health information technology,
• Creating the NHIE Framework, which would result in increased insurer competition,
• Repealing the ban on direct price negotiation between Medicare and drug companies and ending the overpayment of Medicare Advantage plan, and
• Investing in public health and prevention, expanding chronic care management, and supporting an independent institute to conduct comparative effectiveness analyses on technologies and treatment options.

Outstanding issues
• While this plan would significantly increase coverage, it would still leave about 6% of the non-elderly population uninsured. As a consequence, the inefficient and costly safety net system we have today will need to remain in place.
• The approach relies on an employer mandate, which could increase costs to some businesses and engender the same political opposition that has contributed the defeat of past reform efforts.
• The campaign’s cost estimates ($65 billion) may be somewhat low, even if the campaign’s cost-containment initiatives are successful. Much depends on details that are unspecified, including subsidy levels, benefits, reinsurance, and a phase-in schedule. How these are resolved will have significant implications for programs costs.
The Obama plan is that it would greatly increase health insurance coverage but would still leave about 6% of non-elderly US residents without insurance. The plan should receive high marks for increasing the sharing of health care risk through a combination of strategies that would substantially increase access to affordable and adequate coverage for those with the highest health care needs, including those with chronic illnesses. The plan would make great strides in increasing the affordability of care for the low-income population.
The cost-containment initiatives in the plan have the potential to reduce cost growth if aggressively pursued. The fact that the Obama plan would devote $50 billion to help subsidize the adoption of health information technology suggests a seriousness of intent. The plan would promote a model of strengthened insurer competition through the NHIE. It would develop policies to improve prevention and to manage chronic conditions. It would repeal the ban on direct price negotiation between Medicare and drug companies, allow for drug re-importation, and reduce current payments to Medicare Advantage plans. It would invest in public health and prevention, reform medical malpractice, and support an independent institute to conduct comparative effectiveness analysis on technologies and treatment options. The Obama proposal would also dedicate financial resources to developing the types of health information systems and comparative effectiveness data that could make the delivery of medical care more efficient and height quality over time. In general, the Obama plan approaches cost containment on multiple fronts because most individual initiatives by themselves have only small effects.
However, an aggressive pursuit of several of these measures would likely be met by opposition from affected providers, including hospitals and pharmaceutical manufacturers. Further, the savings from many of the cost-containment provisions could take a number of years to materialize.
On the other hand, the approach includes an employer mandate that will almost certainly result in opposition by the business community. The lack of an individual mandate for adults means that the plan would not reach universal coverage, but it could still experience relatively high subsidy costs due to the attraction of higher-cost enrollees into public programs and new subsidized insurance options. The proposed funding is likely inadequate but is probably not far from what is necessary to meet its objectives. The Obama plan does not address the issue of the tax exclusion for employer contributions to health insurance. A cap on this exclusion and indexing it to GDP growth would result in substantial revenues that could help pay for the proposed coverage expansion.