A Responsible Plan to Cover Every Child, Cut Costs for All, and Strengthen the Safety Net

John Edwards has unveiled a bold health care plan that will provide health insurance for every child in America and offer real relief for families struggling to deal with the rising costs of doctors visits, insurance premiums, prescription drugs and other health care costs.

Children first.
"The only way we can tackle the health care problem is to ask for responsibility from everyone: responsibility from parents to make sure their children have health care; responsibility from government to help families insure their kids and deal with the rising costs of health care, and responsibility from drug and insurance companies to bring costs down for every American."

Responsibility.
"When parents bring a child into this world, they have a responsibility to provide a safe home, a good education, and a lot of love. Every parent wants to do the right thing for his or her child. I believe health insurance should be one of those responsibilities and I want to help parents meet that responsibility."

A plan that will work.
"It is wrong that 12 million children are without health insurance. My plan will, for the first time in history, cover each and every one. It takes care of our most vulnerable adults. It helps regular Americans who work their hearts out pay for the high cost of health care. It does so in a way that families and the country can afford."

Details of Edwards' Health Care Plan
For an overview of Edwards' plan, read this Health Care Plan Fact Sheet. For specific information on each part of the plan, read these additional fact sheets:

Taking Responsibility To Cover Every Child In America

Millions of Children Suffer from Lack of Health Insurance. There are nearly 12 million American children under the age of 21 who have no health insurance. These children face serious obstacles. They are much more likely to go without needed medical care or prescriptions. They are much more likely to have untreated chronic conditions and to spend time in the hospital unnecessarily. And they are more likely to have poor attendance records at school. [Kaiser Commission, Children's Health, 2002]
If We Require Every Child to Get an Education, John Edwards Believes We Should Also Require Every Child to Have Quality Health Care. Children can't choose whether to buy health insurance, yet quality health care is every bit as important so they can have a good start in life. Health care should be every bit as much a child's right.

Universal Coverage of Children Is Only Possible If Government And Parents Honor Their Responsibility. More than 85% of parents cover their children today, but that still leaves millions of children uninsured. Recent efforts to expand the Children's Health Insurance Program (CHIP) and Medicaid have been successful, but there are still thousands of uninsured children in every state. Seven million children nationally under 19 are eligible for CHIP and Medicaid but not enrolled.

To Cover Every Child, Edwards Offers a Three-Part Deal. First, he'll make it highly affordable for parents to cover their children, guaranteeing access to high-quality, low-cost coverage and offering parents tax breaks for buying insurance. Most parents already covering their children will get a tax break. Second, he'll make it very easy for parents to cover their children, eliminating obstacles that exist today through automatic enrollment. Finally, he'll require parents to cover children under age 21. Specifically, he will:

• Make High-Quality Insurance Highly Affordable for Every Family Through More Than $25 Billion in Tax Credits: Edwards will offer tax credits for parents to buy insurance for their children from their employers or CHIP. Credits will be refundable to benefit low-income families and will be provided regularly in each period when parents must pay premiums. Credits phase down based on income will be available to all parents earning less than roughly $75,000 and to parents in larger families earning less than $100,000. Credits will be refundable to benefit low-income families and will be provided regularly in each period when parents pay premiums.
  

• Make Quality Health Plans Affordable: Because of the tax credits offered under the Edwards plan:
  

  • For a typical family of four earning about $60,000 per year and already covering their children through their jobs, the only consequence of the plan will be a tax break worth roughly $300.
    

  • No lower-income family (up to about $36,000 for a family of four) will have to pay more than 30 cents a day to insure all of their children. As today, the very poor will be covered for free.
    

  • No family of four earning less than $60,000 will have to pay more than $1 per day to cover their children.

• Build on Today's Employer-Based System: Parents could use their tax credits to help pay for high-quality group insurance from their employers:
  

  • Plans must provide high-quality benefits and reasonable copayments and deductibles, at least as good as CHIP. Specific benefits, such as age-appropriate vaccinations with no copayments, are included.
    

  • Parents will be able to apply their tax credits to the purchase of traditional family plans or child-only health care packages that employers will offer.
    

  • Because Edwards supports the employer-based system, credits may not be used for the individual market.
    

• Help Families Buy into CHIP: Parents could also claim tax credits for coverage through CHIP (if their children are not already eligible for Medicaid or CHIP). Under the Edwards policy, all families will have this option, ensuring that all children will have access to affordable coverage. In addition, families eligible for Medicaid and CHIP will have access to the subsidy for employer insurance and will receive wrap-around services provided by the state program as appropriate. Eligible children can be automatically enrolled in the program that provides them the best care for the lowest cost. Waiting periods for CHIP access will never be imposed, but the Secretary of Health and Human Services will be required to monitor crowd-out closely and will have the authority to act to maintain private contributions to the system.
  

• Make Getting Insurance Extraordinarily Easy: Parents will continue to be able to get private insurance as they do today. If children don't have that insurance, they can be automatically enrolled in CHIP or Medicaid as appropriate when they are born, when they register for school, when they come to health clinics, or when a parent files a tax return. Parents could also enroll their children through consolidated applications for government benefits like California's "Express Lane" pilot program and through web-based applications like Health-e-Arizona.
  

• Require Parents to Cover Their Children: Under the Edwards Plan, parents will get affordable credits and easy access to insurance. If parents find they still cannot afford coverage due to extraordinary circumstances, they will be able to apply for additional help. But parents will have a responsibility to cover their children. Parents who do not provide coverage will receive a warning letter, and parents who still do not cover their children will face a reduction in tax benefits. Their children will be automatically enrolled in the appropriate program.
  

• Fully Fund New State Costs: States are facing the most significant budget crisis since World War II. Under the Edwards Plan, states will be held harmless for any new costs, including startup and administrative costs. Since this new program simply builds on top of the existing CHIP and Medicaid programs, states will be required to continue their current levels of contribution for children's coverage and subject to maintenance of effort requirements for CHIP and Medicaid.
  

Help For Adults And Businesses Struggling Most With High Health Care Costs

In addition to covering every child, John Edwards will expand health insurance coverage to offer more options to tens of millions of Americans who are struggling to pay for insurance. He targets his aid to the adults and businesses that have the greatest difficulty paying for health care. Under federal health insurance programs today, most adults get little help. Those with modest incomes, young adults, and unemployed workers are regularly left out in the cold. Adults between the ages of 55 and 65 often find premiums unaffordable. And small businesses struggle to find affordable, high-quality insurance for their employees. To help members of all these groups, offering assistance to more than two-thirds of America's uninsured and covering more than 8 million adults, Edwards will:

Offer Affordable Coverage to Adults with Modest Incomes: The federal government will fully fund the benefit and administrative costs for states to extend a CHIP buy-in to adults with low and moderate-incomes above current coverage levels. Insurance will be free for adults with incomes below 100% of poverty ($18,400 for a family of four) and subsidized for adults with incomes up to 250% of poverty ($46,000 for a family of four). Single adults and adults without children will also be eligible. States will be required to maintain their current insurance programs for adults. The CHIP benefit package will be improved to make it appropriate for adults. All companies participating in CHIP will be required to offer adult coverage. Adults already eligible for CHIP, Medicaid, or Medicare will not be eligible for the buy-in. The Secretary of Health and Human Services will be responsible for monitoring crowd-out and taking action as appropriate, just as with the Edwards child health program.

Help Small Businesses Cover Their Workers: Small businesses are the engine of America's economy, but our health care system seems designed to keep them from offering health coverage. Many of these businesses don't have the purchasing power or administrative resources to offer insurance. When small businesses do offer insurance, they face fewer choices, higher costs, and fewer benefits. [Wall Street Journal, 2003; Fronstein, 1998; Kaiser Family Foundation and Health Research and Educational Trust, 2002; GAO, 2001]

Edwards will give states the resources they need to create purchasing pools for small businesses. These pools will increase health choices by reducing both insurance costs and administrative burdens for small employers. The pools will be available to those with 50 and fewer employees. In addition, to promote participation, tax credits will be offered to small firms with low-income workforces.

Help Young Adults Get Started: A recent study reports that about two-thirds of adults between the ages of 19 and 29 could not pay a medical bill and/or had to be contacted by a collection agency. One-half reported that they did not receive needed medical care due to cost. Under the Edwards plan, insurance companies will be required to allow families to purchase riders for dependents who currently age out of insurance, allowing coverage for young adults to continue until age 25. States will also have the option of augmenting the federal subsidies in the new adult buy-in policy to further reduce the cost of insurance for this group. [Quinn, 2000]

Support Workers Between Jobs: The number of unemployed workers has been steadily rising under the Bush recession. At the current unemployment rate of above 6%, there are more than 8 million uninsured displaced workers. According to a recent study, almost 75 million Americans lacked coverage for at least part of the year during 2001 and 2002. COBRA health benefits are intended to help individuals who have lost their health insurance after losing their job. COBRA enables workers to continue purchasing their health insurance, paying their old premium, their employer's share, and a small administrative fee. However, many families with an unemployed breadwinner cannot afford this cost, and few families choose to participate in COBRA. Although a COBRA credit was recently created for some displaced workers, it does not do nearly enough to cover many workers. [Etheredge and Dorn, 2003]

Edwards will create a 70% tax credit for the purchase of COBRA. Families with displaced workers will be eligible if they are earning less than 250% of poverty ($46,000 for a family of four) and don't have access to any other employer-sponsored insurance.

Create Choices for 55-to-65-Year-Olds: Almost half of Americans between the ages of 55 and 64 have difficulty paying medical bills. Individuals face premiums that are typically three or four times higher than those for younger Americans. Women who have depended on their husbands for health coverage are particularly vulnerable, often losing that coverage when their husbands retire. The number of 55-to-64-year-olds without insurance is expected to accelerate as baby boomers age. [Schoen et al, 2000; Lambrew, 2001; Sheils and Chen, 2001; Glied and Stabile, 1999]

Edwards will give these Americans more choices and more coverage by allowing older adults to buy into Medicare. Adults must be otherwise eligible except for their age. Individuals will be able to purchase coverage at a community rate, and will then be subject to small additional payments when they enroll in Medicare Part B. In addition, the younger spouses of Medicare beneficiaries could buy into Medicare at full cost if their insurance was dependent upon the employment of their spouses.


Reducing Health Care Costs And Improving The Quality Of Care

Our health system wastes billions of dollars and costs thousands of lives. We spend $1.4 trillion a year on health care, yet more than 41 million people go without heath insurance. Despite the massive spending, there are as many as 98,000 avoidable deaths each year. Drug companies, HMOs, and insurance companies profit handsomely from the status quo, but ordinary patients pay more for less. These problems can't be fixed by spending another trillion dollars or blaming doctors and nurses. The country needs new ideas-and a commitment to taking on the special interests and demanding change.

Nobody has a longer record of taking on the HMOs, the insurance companies, and the drug companies than John Edwards. In the Senate, he led the battle for the Patients' Bill of Rights with John McCain and Ted Kennedy; he co-authored bipartisan generic drug legislation that would save taxpayers $60 billion over 10 years according to the Congressional Budget Office; and he led a floor fight to stop wasteful and misleading prescription drug advertisements. As President, Edwards will pursue seven strategies for lowering health costs:

1. Bring down skyrocketing prescription drug costs;

2. Stop the "paper chase" with information technology;

3. Empower doctors and patients to make better choices;

4. Stop frivolous lawsuits and reduce premiums for malpractice insurance;

5. Ensure consumers get a fair deal from HMOs and insurance companies;

6. Reduce fraud and abuse in government health care programs; and

7. Improve the health and quality of care for all Americans.

Experts have estimated that 30% of health spending in our system does not contribute to health. By cutting just 3 percent of federal spending on health care, the Edwards plan will save taxpayers at least $17 billion per year.

BRING DOWN SKYROCKETING PRESCRIPTION DRUG COSTS
Rising prescription drug costs are a crippling problem for millions of Americans. In June 2003, Edwards offered a six-point plan to take on the drug companies and bring down the crippling cost of prescription drugs. Among his proposals:

• Stop Misleading Drug Advertisements: Pharmaceutical ads have become a multibillion dollar industry. According to a recent study, they are responsible for 12% of the increase in prescription drug prices. Many drug makers spend more on marketing, advertising and administration than on research and development. In June, Edwards offered two amendments on the floor of the Senate to require drug advertisements to provide the whole truth about side effects as well as efficacy compared to placebos and cheaper alternatives. These measures were defeated after intense lobbying by the pharmaceutical industry. As President, Edwards will stop misleading direct-to-consumer advertising and repeal President Bush's rule that unnecessarily impedes efforts to stop misleading drug advertisements.
  

• Quality Comparisons: To control costs and ensure quality, physicians and patients must have comprehensive, up-to-date information about a new drug's efficacy versus other drugs on the market. Under the Edwards Plan, experts from across government will conduct and publish research comparing drug efficacy. The National Institutes of Health will also be required to conduct trials comparing similar pharmaceuticals. The government will then disseminate results in an easy-to-use format.
  

• Make Drug Companies Play by the Rules: Drug companies have often overcharged the government for prescriptions. Upon taking office as president, Edwards will immediately ask the Department of Justice to launch a comprehensive investigation into drug companies' price gouging of taxpayers. He will also create mandatory new fines and penalties for companies and their executives who break the law.
  

• Review Drug Patent Laws: In recent years, drug companies have produced fewer breakthrough drugs and more drugs with only minor improvements - known as "me-too" drugs - that provide big profits for drug companies but few benefits for consumers. Edwards would establish an expert commission, not controlled by the industry, to recommend appropriate changes to existing patent laws.
  

• Sign Edwards Generic Drug Bill: Edwards would sign the generic drug legislation that he co-authored in 2002. The Congressional Budget Office said that his bill would save $60 billion over 10 years.

STOP THE PAPER CHASE WITH INFORMATION TECHNOLOGY
Despite the availability of computers and the Internet, many insurers and hospitals rely on cumbersome paper systems and incompatible computer systems. The outdated "paper chase" causes tragic errors when doctors don't have access to vital patient information (for example, when a patient comes into an emergency room) or misread handwritten medical charts. The system also wastes countless dollars recreating and transporting medical papers and creates unnecessarily complex procedures for patients and doctors to claim insurance benefits. Edwards would:

• Create a Secure National Database for Medical Records and Billing: Edwards believes that all Americans should have standardized medical records, protected by stringent privacy rules, that patients can allow doctors to access from anywhere in the country. He would ask national experts from the public and private sector to design and implement the system and leverage private resources. The national database would:
  

  • Improve care: Doctors could access records, patient histories, and contraindicated drugs or procedures.
    

  • Reduce waste: Doctors must duplicate as many as 20 percent of medical tests because they don't have access to test results when they need them. [New Democrats Online, 2003]
    

  • Expand research opportunities: Researchers could use online records-rendered anonymous through computer coding-to study the most effective medical treatments, a critical step toward evidence-based medicine that will improve health quality and reduce costs. [Ellwood, 2003]
    

  • Simplify billing: When physician orders are entered and executed, billing to the appropriate health plan will occur automatically. Ending redundant forms and endless paper files will allow doctors to care for more patients.

• Support Local Infrastructure: A national medical records system will require a strong local infrastructure. Edwards will increase resources for hospitals through the Agency for Healthcare Research and Quality (AHRQ). Hospitals will receive additional funds for five years to implement information systems that improve patient safety and hospital efficiency, such as:
  

  • Adopting automated medication dispensers that can quickly and accurately fill prescriptions, freeing pharmacists to work more with patients and reducing the risk of prescription errors;
    

  • Developing systems to promote patient-doctor communication, such as email consultations and group consultations and support groups for individuals suffering from the same disorder;
    

  • Creating computerized physician order entry to eliminate lost paperwork and illegible writing;
    

  • Developing computerized patient reminder systems to improve compliance with treatments, such as automatic phone calls home to remind patients to take needed medication to help keep them healthy and out of the hospital; and
    

  • Using handheld devices to communicate results directly to physicians, instead of wasting time trying to find a doctor with urgent information.

EMPOWER DOCTORS AND PATIENTS TO MAKE BETTER DECISIONS

Empower Patients to Participate in Their Care: Informed patients will make better choices and drive health care providers to offer better services for lower costs. Edwards will:

• Create a "Consumer Reports" for Health Care: Edwards will bring patients and providers together to create consumer-oriented systems for assessing and reporting health quality, similar to those under development by groups such as Leapfrog Group and the Pacific Business Group on Health. Eventually, these systems will make it possible to identify hospitals' survival rates for certain operations, even adjusting for patient acuity and other demographic characteristics. The systems will be universal, standardized, and easy-to-use. This system will allow patients to hold providers accountable, driving providers to compete for business. [Chassin, 2002; Lansky, 2002; Hibbard, 2003]
  

• Give Patients Better Information About Medical Treatments: Patients should have the information they need to make informed decisions about their medical treatments. The system for deciding care must be transparent to the patient, rather than cloaked in secrecy. Edwards will require all insurers in the Federal Employee Health Benefits Plan (FEHBP) to communicate with patients over the Internet. He will also give patients greater access to evidence-based treatment guidelines so they can better understand doctors' recommendations. The more objective information that patients have available to them, the better they will be able to participate in decisions about their health and follow instructions once given.

Empower Doctors to Do Their Best Work: Doctors should have support to keep up with constant medical advances. Evidence suggests that some doctors may maintain old routines for many years after new treatments are developed. Edwards will give doctors the tools and time to improve their skills:

• Assess Medical Advances and Share Information: Every year, there are 10,000 peer-reviewed medical trials released. State-of-the-art medical practice is constantly evolving. Edwards will create an honest broker-possibly the Institute of Medicine within the National Academy of Sciences�to evaluate new products and treatments. Doctors will be able to assess the relative merits of different treatments from their offices through access to computerized systems. [Newhouse, 2002; Meyer and Silow-Carroll, 2003]
  

• Improve Medical Delivery Systems: For all of the billions spent on medical research, the federal government spends little on identifying the best means to deliver care-for example, the best design for an emergency room or the best practices for interactions between clinics and hospitals. The Edwards Plan will fund research to streamline and improve health delivery. [Lanksy, 2002; Fernandopulle et al, 2003; Berwick, 2002; Altman et al, 2003]

Promote Pay-for-Performance: Research shows that only the very largest private employers consider quality as a factor when purchasing care. The majority of employers say they have inadequate information for judgments. As a result, most health care purchasers pay the same amount for services regardless of quality. [Hargraves and Trude, 2002; Shaller et al, 2003]
To help consumers choose care wisely and create market incentives to improve care, Edwards will:

• Lead by Example: Edwards will ensure that Federal health care payment systems (such as those in Medicare and Medicaid) reward quality. These best practices will in turn be shared with the private sector. For example, the government might pay higher rates to those providers and plans that provide the very best care; encourage federal employees to enroll in higher-quality programs through lowering cost-sharing for those plans; promote better disease management to reduce costs of chronic illness; and establish penalties for plans that fail to meet critical, easily quantifiable goals, such as childhood immunization rates.
  

• Promote Private-Sector Infrastructure: Edwards will provide grants to private entities to research and develop pay-for-performance systems.
  

REDUCE MALPRACTICE PREMIUMS BY CRACKING DOWN ON ABUSIVE INSURERS, LAWYERS, AND DOCTORS
The rising cost of malpractice insurance for doctors is getting in the way of good health care. In rural areas, some specialists can no longer afford to practice and patients can't get the care they need. To free doctors from crippling insurance costs, without preventing severely injured victims from receiving compensation, Edwards would:

• Crack Down on Insurance Price-Gouging: Some insurance companies use slow and burdensome processes to discourage legitimate claims. Worse still, they set their rates based on a trade-group loss calculation that they know other companies will follow. An obscure 1945 law gives insurance companies a broad antitrust exemption. Congress has even blocked the Federal Trade Commission from investigating insurance company rip-offs. These special privileges must go.
  

• Prevent and Punish Frivolous Lawsuits: Most lawyers are responsible advocates for their clients, but the few who aren't hurt the real victims, undercut the credibility of the legal system, and clog our courts. Before a lawyer can bring a medical malpractice case to court, Edwards will require that he or she swear that an expert doctor is ready to testify that real malpractice has occurred. Lawyers who file frivolous cases should face tough, mandatory sanctions. Lawyers who file three frivolous cases should be forbidden from bringing another suit for the next 10 years � in other words, three strikes and you're out.
  

• Reduce Malpractice and Medical Errors: The Institute of Medicine found that at least 98,000 people die from preventable medical errors every year. In medicine, as in law, a few people cause the most problems: Only 5 percent of doctors have paid malpractice claims more than once since 1990. This same 5 percent is responsible for over half of all claims paid. Edwards will provide resources and incentives for boards to adopt real standards on the �three strikes� model. At the same time, he will encourage doctors to report more medical errors voluntarily so we can learn more about systemic problems.
  

• Offer Direct Aid for Doctors Being Driven From Practice: The three-part plan above will sharply reduce malpractice premiums. To the extent some doctors are still driven from practice in shortage areas by high premiums, Edwards will offer direct aid to keep doctors in business.

DEMAND A FAIR DEAL FROM HMOs AND INSURANCE COMPANIES
Edwards has consistently fought abuses by insurance companies-first as a lawyer, and then as a Senator. In addition to eliminating the special antitrust privileges that allow insurance companies to engage in price gouging, Edwards will:

• Sign a Real Patients' Bill of Rights: Working with John McCain and Ted Kennedy, Senator Edwards led the fight for a real Patients' Bill of Rights. It would guarantee patients the right to see medical specialists, gain direct access to pediatricians, obstetricians and gynecologists, and go to the nearest emergency room without being penalized by their HMO. And it would hold HMOs accountable for providing people the health care they pay for.
  

• Stop Abuses of Patients in Medicare+Choice: Edwards would require insurance companies that participate in Medicare+Choice to make a real commitment to patients. He would make companies agree to participate in Medicare+Choice under five year contracts, and not let those companies cut their benefits and leave seniors with nothing.
  

FIGHT FRAUD AND MISMANAGEMENT IN MEDICARE, MEDICAID, AND VETERANS' HEALTH

Improve Integrity of Medicare and Medicaid: Last year, Medicare paid more than $13.5 billion in claims without proper documentation. The government's anti-fraud enforcement efforts recovered about $1 billion from Medicare and only $43 million from Medicaid. Far more savings can be achieved without impairing either program's ability to serve Americans.

To help protect the integrity of both programs, Senator Edwards would:

• Ensure Federal and State Governments Work Together on Fraud. Medicare is a federally operated program and Medicaid is operated at the state level. As a result, it is possible for one program to penalize a provider for fraud while the other program continues to be defrauded. Under the Edwards Plan, the Department of Justice would develop the communications and data system needed to ensure close cooperation with the fraud unit of every state Medicaid agency.
  

• Require States to Conduct Comprehensive Medicaid Fraud Assessments. States should be required to conduct annual assessments to determine the number of claims that lack appropriate documentation. While already occurring in Medicare, these assessments must be expanded to Medicaid.
  

• Increase Whistleblower Protections at State Medicaid Agencies. The Supreme Court has ruled that whistleblowers at state agencies do not have the same rights as whistleblowers at private entities. In order to prevent states from defrauding federal agencies, whistleblowers should have substantial protections lacking under current law.
  

• Streamline Processes and Educate Providers on Filing Medicare and Medicaid Claims. Medicare and Medicaid are extremely complex programs. The government must invest in simplifying requirements and also ensuring that providers understand billing requirements.

• Conduct a Review of the Government Contractors Paying Medicare Claims. In 2002, one Medicare contractor settled allegations that it failed to properly administer Medicare for $76 million. To be sure the private firms that actually write the checks from Medicare do so appropriately, there must be a complete audit of all such firms.

End Mismanagement in Veterans' Care: The Veterans Health Administration (VHA) has some of the hardest working doctors and nurses in the country. Nonetheless, some veterans receive shocking and intolerable care due to widespread mismanagement. Doctors who work part-time for the VHA are being paid for more work than they actually do � sometimes five times more. VHA has too many doctors in some places and not enough in others. Some patients must wait four months for an appointment. VHA's procurement process wastes taxpayer dollars. [Griffen, 2003; Gayton, 2003]
To give veterans the best possible care, Edwards will:

• Negotiate the best price for the best medical products;

• Use technology to strengthen management controls; and

• Hold managers accountable for meeting benchmarks for quality and access of care.
  

IMPROVE THE HEALTH AND THE QUALITY OF CARE FOR ALL AMERICANS

Add 100,000 New Nurses by 2010: Nurses are the backbone of health care. Under the Edwards Plan, grants will be made available to hospitals and nursing homes to improve the working conditions of all 2.2 million of America's nurses and to draw 50,000 Americans who have left nursing back into the profession. In addition, nursing schools will be expanded and scholarships provided so that another 50,000 nurses will be added.

Reduce Health Disparities: In America, the color of a person's skin should never affect the quality of their health care. Under the health disparity program announced in June 2003, Edwards proposed a national medical translation system to reduce language barriers; increased funding for research on medical disparities; a new health unit within the Civil Rights Division of the Department of Justice to address discrimination in health care; and working on a bipartisan basis to pass a law overturning a Supreme Court decision that deprives individuals of the ability to protect their health care civil rights through injunctive actions.

Promoting a Healthy Lifestyle: Studies show that weight is linked to more than $93 billion in annual health care spending. The Edwards Plan would fund efforts to reduce obesity, including research on prevention, public health education, and school lunch and exercise programs.

Protecting People With Nowhere Else To Go: Strengthening The Health Care Safety Net

America's health care safety net is on the brink of unraveling. Faced with record deficits, states and counties are cutting budgets for public hospitals, clinics, and other health programs. States have recently considered proposals to deny Medicaid and CHIP coverage to 1.7 million people. Most state budgets call for cuts to Medicaid and health programs, including cuts in mental health care, dental care, and supplies such as wheelchairs and diabetes test strips. [Center on Budget and Policy Priorities, 2003]
John Edwards has proposed a plan to extend health insurance to 93% of Americans, covering more than 21 million of the uninsured. But under this or any other health reform plan, America will still need high-quality public hospitals and clinics. Public providers will remain key health providers for tens of millions of Americans. And, in case of an accident, health crisis or terrorist attack, American public hospitals, with their expert trauma centers, must be ready. Public hospitals and clinics are critical for us all.

The Edwards Plan for the Health Care Safety Net. John Edwards proposes new federal spending of $12 billion over 10 years to strengthen the pillars of our public health system. In the short run, these resources will provide immediate relief for an overloaded system. In the long run, they will improve health and generate savings for the American people. Edwards would:

• Support Health Clinics. Double overall clinic funding to help clinics extend their hours, become more geographically accessible, and offer greater access to specialists.
  

• Protect Safety Net Hospitals. Delay planned cuts in aid to public hospitals.
  

• Strengthen and Streamline Medicaid. Simplify enrollment and control costs.

STRENGTHENING HEALTH CLINICS

Health Clinics-Including Community Health Centers, Federally Qualified Health Centers, and Migrant Health Centers-Are Integral to the Health Care Safety Net. These facilities typically operate on shoestring budgets, doing their best to offer a continuum of primary and specialty health care. When clinics fail to provide needed care, people have no choice but to go to emergency rooms for assistance. [Institute of Medicine, 2000]

Today's system is dangerous for patients, who frequently have waited too long for diseases to progress before getting care. It is also dangerous for anyone with a critical need in an emergency room whose treatment is delayed by patients with non-critical conditions. And the system is costly to society because delayed treatment costs all Americans more through higher hospital bills, insurance premiums, and taxes. Yet funding for clinics has effectively been flat, even as the Bush economy has increased demand for clinic services.

Health clinics have the potential to offer health care that is appealing to many busy Americans, not only the poor. While the stereotypical clinic may be a gray office in an out-of-the-way location, there is no reason that clinics cannot be friendly and accessible. The growth of "doc-in-the-box" operations in malls is evidence of Americans' demand for health services that are easily accessible during the workday. Clinics can help fill this void.

The Edwards plan will double support for public health clinics through the new Clinic Preservation and Improvement Program (CPIP). A portion of CPIP funds will be available for day-to-day operations and program improvements. The remainder would be dedicated to the following innovative goals, as well as others:

• Extend Clinic Hours. Extending clinic hours is critical for today's working families. Most public clinics operate 9:00 to 5:00, yet many of their users hold jobs and cannot afford to take leave.
  

• Improve Clinic Locations. Most clinics cannot afford space in easily accessible, high-traffic areas. CPIP will help station clinics in schools and malls.
  

• Assist with Patient Transportation. Many low-income and disabled individuals lack reliable transportation to clinics. CPIP would support paratransit services and transportation vouchers.
  

• Create Mobile Clinics. Hospitals and clinics are often located more than 30 minutes from communities in need, particularly in rural areas. CPIP will support mobile clinics.
  

• Offer Greater Access to Specialists and Dentists. CPIP will support key services that clinics often don't provide, including dental care, mental health care, and treatment by specialists.
  

• Provide House Calls. CPIP resources will support home treatment of the elderly and disabled, as well as well-baby visits to help new parents care for their children.
  

• Help Clinics Obtain Inexpensive Prescription Drugs. Most clinics fail to utilize a special program designed to reduce the cost of drugs. Grants would be made to clinics so they would have the capital to fully leverage the �340B� drug program.
  

• Improve Disease Management. CPIP will support efforts to ensure that chronic patients receive regular care to improve care quality and to help avoid the need for costly hospitalizations.
  

• Strengthen Telemedicine and Information Systems. CPIP will support telemedicine to give clinic patients access to hospital-based specialists. Telemedicine is especially critical in rural areas. Also, funds should be made available to promote electronic record keeping.
  

• Promote Prevention, Education and Outreach. CPIP will support prevention programs for mental illness, obesity, and substance abuse. Clinics could also help fund workers to enroll children and families in the appropriate health insurance program.

PROTECTING SAFETY NET HOSPITALS

In a weak economy, when demand for public services is growing, Washington has cut funding for public hospitals. This is a mistake with tragic consequences for millions of Americans.

The Edwards plan will give hospitals the funding they need by delaying planned reductions in Disproportionate Share Hospital (DSH) program until at least 2006. DSH funds are special government payments to hospitals that see a large number of low-income and Medicaid beneficiaries. Hospitals receiving these payments are the backbone of America's emergency rooms and trauma centers. Under the Edwards Plan, further reductions will be delayed pending a national assessment of the state of America's public hospitals. Hospitals will get the funding they need to make it through the current crisis.

STRENGTHENING AND STREAMLINING MEDICAID

Due to state budget cuts, Medicaid is under enormous pressure. We must build on recent federal efforts to support Medicaid by helping to secure the long term viability of the program.

John Edwards will offer grants to states that agree to undertake key reforms. Due to the current fiscal crisis, these grants will cover 100% of project administration costs and will offer assistance with additional caseload costs. Grants could be used for:

• Simplifying Medicaid enrollment. Many people do not enroll in Medicaid because the enrollment process is too complex. Meanwhile, the bureaucracy wastes time and money by requiring meaningless paperwork. The Edwards Plan would support:
  

  • Low-cost, Internet-based applications that can be completed in public libraries, along the lines that Arizona and other states have already developed;
    

  • Consolidated applications for multiple public programs, such as on California's �Express Lane� pilot program that allows school lunch applications to be used for Medicaid;
    

  • Greater presence of outreach workers in places like public hospitals and health clinics;
    

  • Shorter, simpler, and improved Medicaid and SCHIP application forms and elimination of unnecessary enrollment requirements.
    

  • Eliminate the 5-year ban on Immigrant Enrollment. Under the Edwards plan, the 5-year ban on immigrant enrollment is eliminated. Grants could be used for quick implementation of this policy.

• Implementing Disease Management Strategies. Disease management is a new concept for state Medicaid programs. Such efforts promise higher quality and lower costs through close monitoring of, and work with, chronically ill patients.
  

• Controlling Drug Costs. While states like Maine and New Hampshire have led the way in trying to control drug costs by requiring rebates on drug prices for broad populations, the Bush Administration has blocked these efforts. Many states are hesitant to support rebate programs because of high start-up costs. The Edwards plan would offer grants to develop and implement such programs nationally.
  

• Building Bridges Between Medicaid, CHIP, and the Private Sector. There are millions of people today who are enrolled in Medicaid but who also have access to employer-sponsored insurance. This is a missed opportunity for the government to work with employers to leverage all available dollars for health care spending. Individuals who are eligible for both Medicaid and employer-sponsored insurance should be able to receive their employer's health care as well as any additional benefits provided by Medicaid. Facilitating such "wrap-around" coverage will lower Medicaid costs while at the same time ensuring that Medicaid beneficiaries receive the full range of Medicaid services.

Source: John Edwards for President 2004 Web Site

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