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Also in , AHIP issued a proposal for guaranteeing access to coverage in the individual health insurance market and a proposal for improving the quality and safety of the U. Berkeley School of Law Center on Health, that in essence said that the government should offer a public health insurance plan to compete on a level playing field with private insurance plans. The argument is based on three basic points. Firstly, public plans success at managing cost control Medicare medical spending rose 4.

Secondly, public insurance has better payment and quality-improvement methods because of its large databases, new payment approaches, and care-coordination strategies. Thirdly, it can set a standard against which private plans must compete, which would help unite the public around the principle of broadly shared risk while building greater confidence in government in the long term. Among the proposals was the establishment of an independent comparative effectiveness entity that compares and evaluates the benefits, risks, and incremental costs of new drugs, devices, and biologics.

Although both candidates had a health care system that revolved around private insurance markets with help from public insurance programs, both had different opinions on how this system should operate when put in place. Senator John McCain proposed a plan that focused on making health care more affordable. The senator proposed to replace special tax breaks for persons with employer-based health care coverage with a universal system of tax credits.

In his plan, Senator McCain proposed the Guaranteed Access Plan which would provide federal assistance to the states to secure health insurance coverage through high-risk areas. Senator McCain also proposed the idea of an open-market competition system.


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Barack Obama called for universal health care. His health care plan called for the creation of a National Health Insurance Exchange that would include both private insurance plans and a Medicare-like government run option. Coverage would be guaranteed regardless of health status, and premiums would not vary based on health status either. It would have required parents to cover their children, but did not require adults to buy insurance.

The Philadelphia Inquirer reported that the two plans had different philosophical focuses. They described the purpose of the McCain plan as to "make insurance more affordable," while the purpose of the Obama plan was for "more people to have health insurance. A poll released in early November, , found that voters supporting Obama listed health care as their second priority; voters supporting McCain listed it as fourth, tied with the war in Iraq.

Affordability was the primary health care priority among both sets of voters. Obama voters were more likely than McCain voters to believe government can do much about health care costs. In March AHIP proposed a set of reforms intended to address waste and unsustainable growth in the current health care market.

These reforms included:. On the panel of the "invited stakeholder", no supporter of the Single-payer health care system was invited. There is one bill currently before Congress but others are expected to be presented soon. A merged single bill is the likely outcome. Republicans have also expressed opposition to the use of comparative effectiveness research to limit coverage in any public sector plan including any public insurance scheme or any existing government scheme such as Medicare , which they regard as rationing by the back door.

Republican amendments to the bill would not prevent the private insurance sectors from citing CER to restrict coverage and apply rationing of their funds, a situation which would create a competition imbalance between the public and private sector insurers. On June 15, , the U. However, in a June New York Times editorial, economist Paul Krugman argued that despite these estimates universal health coverage is still affordable. In contrast to earlier advocacy of a publicly funded health care program, in August Obama administration officials announced they would support a health insurance cooperative in response to deep political unrest amongst Congressional Republicans and amongst citizens in town hall meetings held across America.

During the summer of , members of the "Tea Party" protested against proposed health care reforms. Healthcare reform was a major topic of discussion during the Democratic presidential primaries. As the race narrowed, attention focused on the plans presented by the two leading candidates, New York Senator Hillary Clinton and the eventual nominee, Illinois Senator Barack Obama. Clinton's plan would have required all Americans obtain coverage in effect, an individual health insurance mandate , while Obama's provided a subsidy but did not include a mandate.


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  • During the general election , Obama said that fixing healthcare would be one of his top four priorities if he won the presidency. After his inauguration, Obama announced to a joint session of Congress in February his intent to work with Congress to construct a plan for healthcare reform. However, following the adoption of an individual mandate as a central component of the proposed reforms by Democrats, Republicans began to oppose the mandate and threaten to filibuster any bills that contained it.

    Republican Senators, including those who had supported previous bills with a similar mandate, began to describe the mandate as "unconstitutional". The reform negotiations also attracted a great deal of attention from lobbyists , [] including deals among certain lobbies and the advocates of the law to win the support of groups who had opposed past reform efforts, such as in During the August summer congressional recess, many members went back to their districts and entertained town hall meetings to solicit public opinion on the proposals.

    Over the recess, the Tea Party movement organized protests and many conservative groups and individuals targeted congressional town hall meetings to voice their opposition to the proposed reform bills. To maintain the progress of the legislative process, when Congress returned from recess, in September President Obama delivered a speech to a joint session of Congress supporting the ongoing Congressional negotiations, to re-emphasize his commitment to reform and again outline his proposals.

    Instead, the Senate took up H.

    The bill was then used as the Senate's vehicle for their healthcare reform proposal, completely revising the content of the bill. With the Republican minority in the Senate vowing to filibuster any bill that they did not support, requiring a cloture vote to end debate, 60 votes would be necessary to get passage in the Senate. Negotiations continued even after July 7—when Al Franken was sworn into office, and by which time Arlen Specter had switched parties—because of disagreements over the substance of the bill, which was still being drafted in committee, and because moderate Democrats hoped to win bipartisan support.

    However, on August 25, before the bill could come up for a vote, Ted Kennedy—a long-time advocate for healthcare reform—died, depriving Democrats of their 60th vote. Before the seat was filled, attention was drawn to Senator Snowe because of her vote in favor of the draft bill in the Finance Committee on October 15, however she explicitly stated that this did not mean she would support the final bill. Following the Finance Committee vote, negotiations turned to the demands of moderate Democrats to finalize their support, whose votes would be necessary to break the Republican filibuster.

    Majority Leader Harry Reid focused on satisfying the centrist members of the Democratic caucus until the hold-outs narrowed down to Connecticut's Joe Lieberman , an independent who caucused with Democrats, and Nebraska's Ben Nelson. Lieberman, despite intense negotiations in search of a compromise by Reid, refused to support a public option ; a concession granted only after Lieberman agreed to commit to voting for the bill if the provision was not included, [] [] even though it had majority support in Congress.

    With every other Democrat now in favor and every other Republican now overtly opposed, the White House and Reid moved on to addressing Senator Nelson's concerns in order to win filibuster-proof support for the bill; [] they had by this point concluded that "it was a waste of time dealing with [Snowe]" [] because, after her vote for the draft bill in the Finance Committee, Snowe had come under intense pressure from the Republican Senate Leadership who opposed reform. On December 23, the Senate voted 60—39 to end debate on the bill: a cloture vote to end the filibuster by opponents.

    The bill then passed by a vote of 60—39 on December 24, , with all Democrats and two independents voting for, and all Republicans voting against except one Jim Bunning R-KY , not voting. Several weeks after the vote, on January 19, , Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace the late Ted Kennedy , having campaigned on giving the Republican minority the 41st vote needed to sustain filibusters, even signing autographs as "Scott The election of Scott Brown meant Democrats could no longer break a filibuster in the Senate.

    With Democrats having lost a filibuster-proof supermajority in the Senate, but having already passed the Senate bill with 60 votes on December 24, the most viable option for the proponents of comprehensive reform was for the House to abandon its own health reform bill, the Affordable Health Care for America Act , and pass the Senate's bill, The Patient Protection and Affordable Care Act, instead. Various health policy experts encouraged the House to pass the Senate version of the bill.

    In other words, they're exactly the kinds of policies that are well-suited for reconciliation. The remaining obstacle was a pivotal group of pro-life Democrats, initially reluctant to support the bill, led by Congressman Bart Stupak. The group found the possibility of federal funding for abortion would be substantive enough to warrant opposition. The Senate bill had not included language that satisfied their abortion concerns, but they could not include additional such language in the reconciliation bill, as it would be outside the scope of the process with its budgetary limits.

    A few states have taken steps toward universal health care coverage, most notably Minnesota , Massachusetts and Connecticut. Examples include the Massachusetts Health Reform Statute [] and Connecticut's SustiNet plan to provide health care to state residents.

    Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California in , [] Massachusetts in , and Oregon in Both times, Governor Arnold Schwarzenegger R vetoed the bill, once in and again in The percentage of residents that are uninsured varies from state to state. States play a variety of roles in the health care system including purchasers of health care and regulators of providers and health plans, [] which give them multiple opportunities to try to improve how it functions.

    While states are actively working to improve the system in a variety of ways, there remains room for them to do more. One municipality, San Francisco, California , has established a program to provide health care to all uninsured residents Healthy San Francisco. The recommendations must address 1 the phased-in offering of the SustiNet plan to state employees and retirees, HUSKY A and B beneficiaries, people without employer-sponsored insurance ESI or with unaffordable ESI, small and large employers, and others; 2 establishing an entity that can contract with insurers and health care providers, set reimbursement rates, develop medical homes for patients, and encourage the use of health information technology; 3 a model benefits package; and 4 public outreach and ways to identify uninsured citizens.

    The act also establishes an independent information clearinghouse to inform employers, consumers, and the public about SustiNet and private health care plans and creates task forces to address obesity, tobacco usage, and health care workforce issues. The effective date of the SustiNet law was July 1, , for most provisions.

    In May , the state of Vermont became the first state to pass legislation establishing a single-payer health care system.

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    The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. In December , the governor of the state of Vermont suspended plans to implement this single-payer system because of its cost. From Wikipedia, the free encyclopedia.

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    Unsourced material may be challenged and removed. This article needs to be updated. Please update this article to reflect recent events or newly available information. March Obama administration proposals Public opinion Reform advocacy groups Rationing Insurance coverage. Free market Health insurance exchange Nationalized insurance Publicly-funded Single-payer Canadian vs. American Two-tier Universal. Third-party payment models.

    All-payer rate setting Capitation Fee-for-service Global payment. See also: Health Security Express.