Wednesday, January 2, 2008

Answers to a Presidential Questionaire, Where do candidates stand on disability issues?

For voters with disabilities a hot topic in this years Presidential campaign is affordable access to health care. AAPD, ADAPT, NCIL, and SABE released responses to a questionaire they sent to all of the presidential candidates. Here are the candidates answers to health care questions.

Q: What steps would you take to ensure that people with disabilities have access to affordable, quality health care that is responsive to their needs?

Obama: As president, I will sign a universal health care plan into law by the end of my first term in office. I will moderAAPD, ADAPT, NCIL, SABE Questionnairenize the U.S. health care system to improve quality and reduce costs by $2,500 for a typical family. And I will increase investment in public health to prepare and protect Americans against emerging health threats and to reduce rates of preventable diseases.
My plan will cover the uninsured and lower costs to families and businesses. I will allow people who do not have access to group coverage through their employers or public programs (such as Medicaid, SCHIP, and Medicare) to buy into a national pool, which will offer a new public plan similar to the one I have as a member of Congress, and private plans that offer comprehensive benefits and meet quality standards. Federal subsidies will be made available to those who need it, to make coverage more affordable. And employers will have access to reinsurance to protect them from volatile and high increases in the cost of insurance. Finally, my plan will mandate health insurance coverage for every child in America.
My health care reform plan recognizes that although all Americans are affected by problems with our health care delivery system, certain patient populations are significantly more likely to experience difficulties gaining access to health care and to receive lower quality health care. I will require that all health care providers collect, analyze and report data on the quality of health care given to vulnerable populations, including those with disabilities, to ensure appropriate care and good health outcomes. My plan also emphasizes care coordination and integration, which is particularly important for individuals with disabilities who often have multiple providers. Last but not least, I will support additional training of health care workers so that they are better able to address the needs of disabled populations.

Richardson: My plan for universal coverage would ensure that Americans—with or without disabilities—would have access to affordable, guaranteed coverage.

Edwards: I understand that health care is of special concern to people with disabilities. Not only do they have particularly important needs, but their independence often depends on good health care.
We must act now to guarantee universal health care coverage for everyone in America. I am proud to be the first major presidential candidate to propose a specific plan to transform America's health care system and guarantee quality affordable health care for every man, woman and child in America. Under my plan, businesses will either cover their employees or help pay their premiums. The government will make insurance affordable through new tax credits and by leading the way toward more cost-effective care. New “Health Care Markets” will give families and businesses purchasing power and a choice of quality plans, including one public plan based on Medicare. Finally, once these steps have been taken, all American residents will be required to take responsibility and get insurance. Insurance companies will not be allowed to discriminate against people with preexisting conditions or disabilities.
Under my plan, families without insurance will get coverage at an affordable price. Families that have insurance today will pay less and get more security and choices. Businesses and other employers will find it cheaper and easier to insure their workers.
Beyond guaranteeing coverage, there is much that we can do to ensure that people with disabilities receive quality care. Medical training and education should help primary care physicians, dentists and allied health practitioners to work with adults with disabilities. Currently, federal funding for training physicians to treat patients with disabilities is focused on pediatric practitioners, but most people with disabilities are adults. Under my plan, we will establish a non-profit or public organization – possibly within the Institute of Medicine – to research the best methods of providing care, drawing upon data from Medicare and the new Health Care Markets and from medical experts from across the nation. Understanding and disseminating best practices for treating patients with disabilities will be an essential part of this initiative.

Clinton: As President, I will enact legislation to provide high quality affordable health care coverage for all Americans, including those with disabilities. I will ensure that disability advocates are included in the process of developing the legislation to provide health care coverage for all Americans, and that the system that I ultimately sign into law addresses the particular needs of individuals with special needs. Today, even those individuals who have health insurance are often under-insured – that is, when they need treatment, their health insurer denies the claim. These practices can have a particularly damaging impact on individuals with disabilities who often need care urgently. I have been working to address the major problems in our health care system for fifteen years. I have taken on the health insurance companies and other special interests that too often work against the interests of those in need of care. In addition to addressing discriminatory insurance practices, we have to make sure that there’s affordable health coverage for all. To that end, we need to develop the best approaches to delivering quality cost effective care that meets the needs of individuals instead of continuing with the antiquated policy approach of today that applies a one size fits all model
Beyond co-sponsoring the Medicare Disability Waiting Period Act of 2005, I’ve also supported the numerous and inadequate state-based medically needy programs that have a bias towards nursing home rather than home and community based coverage. I believe it’s time to focus on patients needs rather than on bureaucratic constraints imposed long ago. As President, I will continue to champion these policies.

Dodd: I believe that the federal government has a responsibility to ensure that every American receives affordable, quality medical care that meets all of their needs. As President, I will call on the federal government to create a health insurance marketplace based on, and parallel to, the Federal Employees Health Benefit Plan (FEHB). Every employer and individual will be given the chance to go to the marketplace to purchase high-quality, affordable health care or, if they wish, keep their existing insurance arrangements. No one will be forced into the marketplace, and individuals, as well as businesses, will contribute based on their ability to pay. By focusing on prevention, and by investing in technology and data collection for better care and better efficiencies, we can better serve all populations of patients. Savings in better care and better efficiencies will finance new coverage. In a Dodd Administration, universal health coverage will be achieved through universal responsibility and universal access will mean access to the doctors, treatments and medical equipment that an individual needs.

Q: How or will you use managed care principles to deliver healthcare services?

Obama: Important medical decisions should be made between patients and doctors, and my health care reform plan will ensure that insurers do not prevent disabled Americans from getting the care they need. My plan will constrain costs and adopt those managed care principles that work, such as the use of modern health information technology, disease management, care coordination and drug price negotiation, to achieve health care quality improvement and savings in the system that can directly benefit individuals and families through lower premiums. My plan will not contain costs at the expense of quality of care. To the contrary, my plan will both reduce health care costs and improve the quality of care.

Richardson: Sometimes managed care is the best way and sometimes not. Managed care organizations have brought many successful applications to health care and when applied effectively provide patients with coordinated care, case management, preventive health care and ensures that providers are well qualified. People, however, like choices and sometimes managed care eliminates the choice of a desired hospital or specialist due to a restricted network. My model for universal coverage preserves choice.

Edwards: Managed care has shown some success in managing the health needs to people with chronic health conditions and it should be a choice for people with disabilities. However, people with disabilities need access to specialists and care that is not artificially limited by narrow definitions of medical necessity.
There are also other ways to integrate care across multiple settings. I have called for investments in information technology and other initiatives to ensure that individuals with disabilities do not fall victim to the fragmentation of care. Something is wrong, for example, when the quirks of disparate payment systems – Medicaid reimbursing for institutional care, while Medicare pays for doctors – prevent health care providers from sharing information that could help patients.

Clinton: Poorly run fee for service as well as managed care is the wrong prescription for everyone, particularly people with disabilities. Rather than applying old line thinking of managed care or fee for service, I believe we should move towards patient-centered care. When my husband was President, I lead the fight for the Patient’s Bill of Rights in order to protect patients’ access to specialty care. I have also proposed establishing an independent public-private Best Practices Institute. This Institute would be a partnership among the public and the private sector that would let doctors, nurses and other health professionals know what drugs, devices, surgeries and treatments work best. These programs will be able to allow us to deliver the most affordable, and the highest quality, healthcare services to all Americans.

Dodd: Modeled on the Federal Employees Health Benefit Plan (FEHB), the Dodd healthcare plan will provide individuals with a wide variety of choices in choosing the type of health care plan that best fits their needs.

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