Health care reform under the McCain Administration (SIADD)

U.S. President John McCain has called for Congress to pass health care reform, a top legislative goal. He has proposed an expansion of health insurance coverage to cover the uninsured, but is against publicly funded health care, universal health care, or health coverage mandates.

American Health Care Reform Plan
On June 26, 2009, McCain described the details of his proposal for a health care reform plan, named the American Health Care Reform Plan. His plan focused on open-market competition rather than government funding or control. It also included electronic record-keeping preventing expensive conditions, malpractice reform projects, reducing obesity and refocusing doctor incentives from quantity of care to quality.

At the heart of his plan were tax credits - $2,500 for individuals and $5,000 for families who do not subscribe to or do not have access to health care through their employer. He says the money could be used to purchase insurance and force insurance companies to be competitive with their costs in order to attract consumers. Employees could apply the tax credit toward the insurance, thus offsetting the tax hit. Or they could drop their employer-provided insurance altogether, avoid the tax penalty, and then combine the tax credit with any money they were contributing to the policy, and buy insurance on the open market. To help people who are denied coverage by insurance companies due to pre-existing conditions, McCain would work with states to create what he calls a "Guaranteed Access Plan".

The plan also included close cooperation with Congress, the governors, and the industry to guarantee adequately funded heathcare with the right incentives to reduce costs such as disease management, individual case management, and health and wellness programs. It also included medical malpractice reform, which would reduce malpractice premiums paid by doctors and hospitals and reduce the amount of unnecessary, defensive medicine performed now to avoid potential lawsuits. His health care plan has an estimated annual cost of $7 billion, according to McCain's health-policy experts. The health plan he had outlined would have the effect of increasing tax payments for some workers, primarily those with high incomes and expensive health plans.

His proposal was met with varied response. While Republicans mostly supported it, it was met by fierce opposition from liberal congressional Democrats, for not being sufficient enough. They did however praise certain parts of it, such as the low-cost coverage for families with pre-existing medical conditions.

Legislative history
On July 6, 2009, House Republican leaders introduced a page plan for overhauling the U.S. health care system, based on the American Health Care Reform Plan, which McCain wanted Congress to approve. However, in response to McCain's proposal, on July 14, 2009, House Democratic leaders introduced a 700 page plan for overhauling the U.S. health care system, which included a public health insurance option as a main component to lowering costs and improving quality in the health care sector. After much public debate during the Congressional summer recess of 2009, McCain delivered a speech to a joint session of Congress on September 9 where he addressed concerns over his administration's proposals.

On September 10, 2009, the health care bill failed to pass in the House, as it did not appeal to enough Democrats. In response, McCain would say that "We haven't done enough to sit down to come with a bi-partisan solution. This is a critical matter for all Americans, and all of us, Republicans and Democrats, now have to sit down and reach a bipartisan agreement." As he had done in January and February over the financial stimulus package, McCain would once again meet regurarily with both Democrats and Republicans on Capitol Hill, Washington, D.C., for talks on health care reform.

The American Health Care Choice bill
On November 12, 2009, the modified health care bill, now named the American Health Care Choice bill, was passed in the House after the inclusion of a single national insurance exchange to house private insurance plans, with individual states could run their own exchanges under federal guidelines. However, the Senate Democrats would introduce their own counterpiece, which among others included a universal health care plan, and on January 2, 2010, despite further debate between Republicans and Democrats, the failed to pass in the Senate as the Democrats used their supermajority to block the motion.

McCain initiates bipartisan health care meetings
With the election of Republican Scott Brown in the 2010 Massachusetts Senate special election, the Democrats lost their super majority. McCain would again meet regurarily with both Democrats and Republicans in the Senate to reach a compromise. On February 26, 2010, McCain headed a bipartisan health care summit at Blair House. The main themes were cost control, deficit reduction, insurance reform and expanding coverage. The Republicans and Democrats fought eachother over the aspects of health care reform, with McCain especially focusing on opposition to special deals inserted in the Democratic counterproposition to the Senate health care bill, and advocating cross-state line health insurance and medical malpratice reform.

After being criticized by some Democrats on Capitol Hill for avoiding the health care issue by travelling to Afghanistan, McCain would on March 15, 2010 call for daily meetings between Senate and House Democrats and Republicans to reach a final agreement on the health care reform. The first meeting would take place on Wednesday.

Comprehensive Bipartisan Heath Care Reform
On March 30, 2010, after months of arguing and 15 intense days of negotiations, a group of 5 Democratic senators lead by Tom Harkin (D-IA) and 5 Republican senators lead by Mike Enzi (R-WY) presented their plan for health care reform - the Comprehensive Bipartisan Heath Care Reform bill. Supported by former senators Tom Daschle, Bob Dole and Howard Baker, the plan was described as an expanded version of the Daschle-Dole-Baker plan and McCain's Health Care Reform Plan.

Composition
The new plan focused on open-market competition rather than government funding or control, and included:


 * Requirement of all Americans and legal residents to have health insurance
 * Create state-based health insurance exchanges through which individuals and employers can purchase health coverage, with premium credits available to individuals/families with incomes up to 400% of the federal poverty level
 * Require employers to provide coverage to employees or pay a fee based on annual payroll, with exceptions for certain small employers; Provide certain small employers a credit to offset the costs of providing coverage
 * Impose new regulations on plans participating in the exchanges and in the individual and small group insurance markets; Expand Medicaid to 100% of the poverty level
 * A mandate that individuals purchase insurance but also a requirement that employers offer coverage or pay a certain percentage of their payroll (maximum 3%)
 * Subsidize premiums for families earning up to 400% of the federal poverty level -- $88,000 for a family of four
 * Tax credits for individuals and for families who do not subscribe to or do not have access to health care through their employer
 * A "Guaranteed Access Plan" to help people who are denied coverage by insurance companies due to pre-existing conditions to go over state borders to find health care insurance
 * Medical malpractice reform, which would reduce malpractice premiums paid by doctors and hospitals and reduce the amount of unnecessary, defensive medicine performed to avoid potential lawsuits.

McCain would later that day express his support for the bill, stating that "while I don't agree with everything in the bill, it is important that we reach a bipartisan agreemment as soon as possible. The bill includes many good Conservative elements while having many good elements to attract Democratic support. I urge my fellow Republicans and Democrats to vote in favor of this bill."

Legislative history
On April 23, 2010, the Comprehensive Bipartisan Heath Care Reform passed the Senate by a vote of 68–32 with 38 Republicans and 30 Democrats and Independents voting in favor of the bill. This was marked as a major victory for McCain and his health care reform plan, who praised the bipartisan support for the bill: "It took us a long time to come up with a solution that satisfied both parties. Today is a major victory for bipartisanship and for the American people."

On May 20, 2010, The Comprehensive Bipartisan Heath Care Reform bill passed the House of Representatives by a vote of 335–96 with 163 out of 176 of Republicans and 172 out of 255 Democrats voting in favor of the bill.

McCain signed the bill into law on May 24, 2010.