NurseWeek/Nursing Spectrum asked Republican presidential candidate U.S. Sen. John McCain, R-Ariz., and Democratic presidential candidate U.S. Sen. Barack Obama, D-Ill., how they would address health insurance reform and healthcare workforce issues, as well as asking for more details about each of their plans. Here are the e-mail responses from their respective campaigns. For more details about the candidates' health plans, visit their Web sites at www.JohnMcCain.com and www.BarackObama.com.
Obama's Plan Regarding Nursing Shortage
Q. How will there be enough nurses and other clinicians to carry out the wellness and prevention programs Sen. Obama talks about in his plan?
A. The nursing workforce shortage ranks as one of the top issues facing our healthcare system. Nurses play a critical role in every aspect of patient care, including care provided in schools, public health departments, clinics, hospitals, and long-term care facilities. They also serve as administrators and executives in clinical and policy settings. As such, national efforts to expand health coverage and improve healthcare quality are dependent on an adequate supply of highly trained and experienced nurses.
And yet, many young adults are choosing not to enter the nursing profession, and a significant number of current nurses are switching careers or retiring early.
Barack Obama knows that working conditions are one of the main factors contributing to this trend. To address the growing nursing shortage, Sen. Obama will —
• Support minimum nursing staff ratios and limitations on overtime, to keep both nurses and patients safe
• Reauthorize Title VIII training programs, with greater financial incentives for students and nurse faculty, including scholarships and loan repayment
• Expand and accelerate health system redesign, especially initiatives emphasizing multidisciplinary care and those targeting the most challenging work environments, such as EDs
• Support adoption of health information technology, which will help to streamline processes of care, increase efficiency, and minimize needless paperwork and administrative requirements
• Continue to recognize and support nurses' right to organize
Q. What kind of upfront expenditure will these programs and IT investments require, and how will they be paid for?
A. Barack Obama's plan will cost approximately $50 billion to $65 billion in new federal spending per year. He will pay for this plan by rolling back the Bush tax cuts for Americans earning more than $250,000 per year and retaining the estate tax at its 2009 level.
Given the inefficiencies in the system, Sen. Obama can reduce costs for all Americans, improve quality, and provide coverage for the underinsured and uninsured. He proposes a plan that does this by making needed investments in improvements in the system that will lower costs.
Q. How much will the national health insurance plan cost?
A. Barack Obama is committed to making sure healthcare is affordable to all Americans under his plan. He has proposed major investments in prevention, health information technology, and chronic care management to ensure reducing healthcare costs. Under his plan, over time, healthcare costs will be lowered by $2,500 for all families.
Q. How will insurance reform be enacted? Will it be left up to the states, or will there be some sort of national legislation to reform the insurance industry?
A. Barack Obama will enact federal healthcare reform legislation by the end of his first term in office. Sen. Obama's plan builds on and improves the current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under his plan, Americans will be able to maintain their current coverage if they choose and will see the quality of their healthcare improve and their costs go down.
Sen. Obama's plan also addresses the large gaps in coverage that leave millions of Americans uninsured. Specifically, his plan will —
* Establish a new public insurance program available to Americans who do not qualify for Medicaid or SCHIP, nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees
* Create a National Health Insurance Exchange to help Americans and businesses that want to purchase private health insurance directly
* Require all employers to contribute toward health coverage for their employees or toward the cost of the public plan
* Mandate that all children have healthcare coverage
* Expand eligibility for the Medicaid and SCHIP programs
* Allow flexibility for state health reform plans. His plan will be enacted by Congress but builds on what's been working in the states
McCain's Plan Regarding Nursing Shortage
Q. How will Sen. McCain address workforce issues such as safe staffing in hospitals, a shortage of nursing faculty, and the need to provide more nurses in the future?
A. To ensure that we have an efficient healthcare delivery system that provides high quality care to Americans at affordable prices, we need to ensure that it is staffed with qualified healthcare professionals. Addressing the healthcare workforce crisis is an important priority for John McCain.
He will ensure that there are proper incentives in place to address the nursing shortage. First, we need to encourage more public and private sector scholarship programs and loan repayment incentives. Second, we need to ensure that the workforce of the 21st century is diverse and equipped to provide culturally competent care. Third, we need to ensure appropriate funding for programs such as the National Health Service Corps and HRSA Health Professions Programs to ensure greater participation in areas of critical shortage, especially in rural areas. Finally, we need to start recruiting young nurses and other health professionals by offering more internships and fellowships and enhancing leadership training programs and promoting retention efforts.
Q. How will Sen. McCain's health plan provide affordable insurance for people with pre-existing conditions?
A. The current environment for individuals wanting to purchase their own healthcare plan is limited, so John McCain is proposing insurance reforms. No American should be denied coverage simply because of a pre-existing condition. John McCain would create a new non-profit guaranteed access plan, or GAP, to help those who have trouble getting insurance. He would provide new funding and guidance for the states to create GAP plans that will allow people who are currently denied coverage to buy policies at affordable prices.
This would not be another unfunded mandate to the states or a new federal entitlement program but rather a partnership between the federal government, the states, insurers, patients, and the medical community. There would be reasonable limits on premiums, and additional assistance would be available to help people with lower incomes.
Q. If a young, self-employed person does not want to use his or her $2,500 tax credit to buy health insurance, can the entire amount be placed in a health savings account, or must at least a portion of the credit go to an insurance company?
A. The $5,000 refundable tax credit for American families ($2,500 for individuals) proposed by Sen. McCain would go toward purchase of new health insurance or simply to keep the current coverage, including employer-sponsored insurance. The choice will be up to the family. Those obtaining insurance coverage that costs less than the credit can deposit the remainder in expanded health savings accounts.
Q. Will Sen. McCain provide for a way to standardize or expand the scope of nurse practitioners?
A. Sen. McCain believes improving access for American families is an important goal of his healthcare reform agenda. Nurse practitioners working in retail clinics are a cost-efficient and convenient way to provide better access for basic healthcare needs. This is a model that Sen. McCain likes and will continue to promote as part of his overall healthcare reform plan to provide access to quality and affordable coverage for American families, including keeping their current coverage.
Q. What are the main benefits of Sen. McCain's plan for nurses and their patients?
A. John McCain believes that all Americans should have access to quality and affordable coverage of their choice, including keeping their current coverage. American families — not government bureaucrats or insurance companies — should choose the coverage that best meets their individual needs. So if a family feels comfortable dealing with a doctor and/or nurse of their choice, they should be able to continue that relationship. As an integral part of our healthcare system, nursing professionals will play an important role in the McCain vision for healthcare reform to reward quality, promote prevention, and deliver healthcare more effectively and efficiently.
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