John McCain on Health Care Republican nominee for President; Senior Senator (AZ)

Sub-sections under Health Care:
• Voting Record
• Other issues under Health Care

Healthcare reform requires cultural change over a generation

The kind of change we need--the kind that Senator McCain and I were talking about in Sioux City, isn't merely a programmatic switch, but a cultural change, one that will take a generation to accomplish, not just an election cycle. And here we run up against one of the dirty little secrets of politics. People who run for office like to champion issues that they can address during their term of office.

Get healthcare records online to reduce costs

McCAIN: It really is the escalating costs of health care that’s inflicting such pain on working families and people across this country. And I am convinced we need to do a lot of things. We need to put health care records online. The V.A. does that. That will reduce costs. We need to have more community health centers. We need to have walk-in clinics.

Mandated heath insurance is Big Government at its best

OBAMA: Here’s your fine--zero.

McCAIN: Zero?

OBAMA: Zero, because as I said in our last debate and I’ll repeat, I exempt small businesses from the requirement for large businesses that can afford to provide health care to their employees, but are not doing it.

50% credit for businesses who provide employees insurance

OBAMA: If you’ve got insurance through your employer, you can keep your insurance. We estimate we can cut the average family’s premium by about $2,500 per year. If you don’t have health insurance, then we’re going to provide you the option of buying into the same kind of federal pool that both Sen. McCain and I enjoy as federal employees. We’re going to make sure insurance companies can’t discriminate on the basis of pre-existing conditions. We’ll negotiate with the drug companies for the cheapest available prices. We are going to invest in information technology to eliminate bureaucracy and make the system more efficient.

Put health records online, to reduce medical errors

A: You really identified one of the really major challenges that America faces. Co-payments go up, which make people less & less able to afford health insurance. And we need to do all of the things that are necessary to make it more efficient. Let’s put health records online, that will reduce medical errors, as they call them. Let’s have community health centers. Let’s have walk-in clinics. Let’s do a lot of things to impose efficiencies

Health care is a responsibility: just make it available

McCAIN: I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. And with the plan that I have, that will do that. But government mandates I’m always a little nervous about. But it is certainly my responsibility. It is certainly small-business people and others, and they understand that responsibility. American citizens understand that. Employers understand that.

OBAMA: Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can’t pay their medical bills--for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies--there’s something fundamentally wrong about that.

FactCheck: Plan is $5,000 per family, not $5,000 per person

Bring together smart Americans to solve Medicare

McCAIN: What we have to do with Medicare is have the smartest people in America come together, come up with recommendations, and then, like the base-closing commission idea we had, then we should have Congress vote up or down.

OBAMA: If we get our tax policies right so that they’re good for the middle class, if we reverse the policies of the last eight years that got us into this fix in the first place and that Sen. McCain supported, then we are going to be in a position to deal with Social Security and deal with Medicare, because we will have a health care plan that actually works for you, reduces spending and costs over the long term, and Social Security that is stable and solvent for all Americans and not just some.

$5,000 refundable tax credit for every family

OBAMA: I make sure that we have a health care system that allows for everyone to have basic coverage. McCain talked about providing a $5,000 health credit. Now, what he doesn’t tell you is that he intends to, for the first time in history, tax health benefits. So you may end up getting a $5,000 tax credit. Here’s the only problem: Your employer now has to pay taxes on the health care that you’re getting from your employer, and if you end up losing your health care from your employer, you’ve got to go out on the open market and try to buy it. It is not a good deal for the American people.

Family should make health decisions, not federal government

McCAIN: I want to make sure that we’re not handing the health care system over to the federal government which is basically what would ultimately happen with Obama’s health care plan. I want the families to make the decisions between themselves and their doctors, not the federal government.

FactCheck: Obama’s plan is voluntary for adults

Obama said, “Your employer now has to pay taxes on the health care that you’re getting from your employer.” McCain’s plan doesn’t call for taxing employers on health care benefits; it would instead tax employees. Employees don’t pay taxes on their health insurance benefits. Under McCain’s plan, they would.

McCain also misrepresented Obama’s plan when he said that his opponent favored “handing the health care system over to the federal government.“ McCain made a similar claim in his acceptance speech, when he said that Obama’s plans would ”force families into a government run health care system.“ We called it false then and we stand by that. Obama’s plan mandates coverag for children, but not for adults, and it does not require anyone to be covered by a nationalized system. Obama’s plan expands the insurance coverage offered by the government, but allows people to keep their own plans or choose from private plans as well

FactCheck: McCain’s $5,000 health tax credit would be taxed

But he failed to mention what he would also take away. Under his plan, workers would be taxed on the value of any health benefits paid for by their employers, which isn’t the case under current law.

McCain didn’t include that fact in an ad his campaign aired in May touting his health care plan, either. As we said at the time, the credit isn’t a $5,000 windfall--it’s designed to cover the increased taxes families with employer-sponsored insurance would have to pay.

[Our experts tell] us that there would be “a lot of winners and losers” under McCain’s plan. Those with lower incomes and employer-sponsored insurance might fare better, because they’d be taxed at a lower rate than those in higher tax brackets.

Large tax credit for families to buy their health care

1997: Give FDA more regulatory powers over tobacco

In the decade since McCain's bill died in 1998, he has done NOTHING to press the issue further. He did not introduce the bill, nor did he attempt to introduce a modified version.

Harness market competition for comprehensive reform

Preserve quality of health care by individual responsibility

A: The real question is: How are we going to keep health care costs down, because we have the highest quality of health care in the world in America today? And unlike the Democrats, I’m going to preserve that quality of health care, and at the same time stop the inflation & the skyrocketing costs of health care. And there’s a couple of principles:

• To make the recipient of the health insurance much more responsible in health-care costs.
• To address wellness & fitness.
• To give every American family a $5,000 refundable tax credit so they can go anyplace in America to acquire the health insurance policy that best suits their needs.
• And, if they’ve got money left over, then invest it in a health savings account.

Give individuals $2500 refundable tax credits for healthcare

A: Last year, the Medicaid inflation was 10%. No program in the world can survive under that. So of course we want to remove the employer tax, and tax incentives, and move it to the individual. Give the individual a $2,500 refundable tax credit, a family a $5,000 tax credit. If you need to have people in special categories such as congenital diseases, we may have to set up a fund to care for those. But the key is, make health care in America affordable and available. Don’t destroy it, as the Democrats want to do.

Control health costs so manufacturers stay competitive

A: I agree with that, but I think we in Washington have an absolute requirement to bring health care costs down. The differential between Toyota and General Motors [due to healthcare costs affects each cars’ cost by] $1,700. It’s our responsibility to stop the cost aspects of health care, which is endangering the profitability and the competitiveness of our Detroit workers. So of course they have to do it on their own. But it is our job to create a climate where we have both a safe and secure Social Security system but also health care costs under control so that they can be competitive with foreign products. By the way, there are automobile manufacturers moving in the southern part of this country, as you know, that are doing very well because American workers are the most productive in the world.

Stumped by whether contraceptives prevent spread of AIDS

Q: Do you think contraceptives help stop the spread of HIV?

McCain: (Long pause) You've stumped me.

Q: I mean, I think you'd probably agree it probably does help stop it?

McCain: I'm not informed enough on it. I've never gotten into these issues before.

McCain HAD gotten into those issues before, acknowledging the link between contraception and HIV prevention, and supporting federal money to purchase condoms. In 2004, as the Democratic National Committee has gleefully pointed out, McCain answered yes to a question posed by Project Vote Smart: "Should aid to African nations for AIDS prevention programs fund distribution of contraceptives?" And on Meet the Press in Feb. 2002, McCain said: "I think we need to use every means possible to try to eradicate this HIV/AIDS epidemic. But I do believe it's appropriate to emphasize abstinence and other ways, as well, and give them priority."

No mandated universal system; no mandated insurance coverage

He said he’s been working on a plan ”for a long time“ but ”it’s a very tough issue.“ One way, he said, would be to expand community health centers and the S-CHIP program, offer tax incentives for poor people, put health care online, medical malpractice reform and promote health savings accounts. However, he said, one problem getting everyone covered ”is there’s a lot of healthy Americans that say I just don’t want health insurance.

We should be able to reimport drugs from Canada

Include a health savings account in healthcare reform

The problem with health care in America is inflation

Supports tax-free medical savings accounts & tax credits

McCain supports the following principles regarding healthcare:
• A Patient’s Bill of Rights, including appeal mechanisms when claims are denied, & the right to sue when claims are denied.
• Expanded eligibility for tax-free medical savings accounts
• In favor of limits on the amount of punitive damages awarded in medical malpractice lawsuits.
• Expanded prescription drug coverage under Medicare.
• Tax credits to individuals and small businesses to offset the cost of insurance coverage.

1989: No mandatory catastrophic Medicare coverage

An editorial by McCain about catastrophic health care coverage [said] mandatory participation in the program would cost some senior citizens as much as $800 a year for coverage. The Senate voted overwhelmingly against McCain: 58 to 40.

1993: To socialize healthcare would be to ruin it

[But the Clinton plan, according to McCain], would destroy America’s health care system as it had come to be known---the best in the world. McCain was also worried about the Clinton plan’s distribution of money. “All Americans deserve the opportunity to obtain health care coverage of their choice,” McCain wrote

“I hope that we will never see the day in which the government tells us which health care plan we may enroll in or who will provide the care. To socialize our health care system, as the Clinton reform plan would, will be to ruin it.

Greater consumer access to generic drugs

McCain threw himself into the struggle over the patients’ bill of rights, applying some of the lessons he’d learned from the campaign finance fight, most especially the benefits of getting others invested in the bill by having them sponsor amendments that were adopted. The bill passed by the Senate in late June by a vote of 59-36. When Bush threatened a veto, McCain issued a statement saying that he was “disappointed” but then he went on to take strong issue with some of the points in the President’s veto threat.

1998 tobacco bill attempted regulation via $1.10/pack tax

Slowly but surely, however, things began to unravel, precipitated by the tobacco companies' media blitzkrieg against the McCain bill. Ultimately, the tobacco companies spent nearly $50 million in media spots.

The tobacco industry advertisements fixed on one subtle, though not insurmountable contraindication to the McCain bill. If tobacco was indeed addictive, then the addicted smoker was all but compelled to pay increased taxes. The fact that the majority of cigarette smokers were in lower income brackets made it an even more regressive tax. The McCain bill failed in the Senate.

Favorite cause: Cleft-palate surgery for children

Higher taxes on cigarettes

Matching funds for seniors citizens’ prescription drugs

Expand health insurance to 11 million uninsured children

Keep health care promises to aging veterans

Address powerlessness when faced with health care crises

Too many Americans feel powerless when faced with a health care crisis in their personal life [because]
• Our complicated health care system intimidates and confuses many Americans.
• Many of us fail to fully examine the coverage provided until we become ill.
• health care [has become] depersonalized, focused more on profits than on proper patient care.

“Patient rights” means value human life over dollars

Expand medical savings; community health; & tax deductions

Patient Rights: access; MDs over HMOs; grievance process

Several principles must guide our health care debate:
1. Put patients and doctors in charge of their own health care, not HMO bureaucrats
2. Improve access to affordable health care
3. Choice of doctors to meet health care needs
4. Guaranteed access to emergency care
5. Continuity of care when employers change
6. Doctors must be able to communicate openly and fully with their patients
7. A free and fair grievance process in the event an HMO denies medical care, including relief in the courts.

Allow paying extra for choice of doctors & care

Full doctor-patient discussion even when it costs HMO

Supports patient rights; regulate nicotine as a drug

McCain supports the following principles regarding health issues:
• Support legislation to define and enforce the rights of insured patients
• Classify nicotine as a drug and cigarettes as drug delivery devices regulated by the FDA.

More tax-deductible health costs; limits on malpractice

McCain supports the following principles regarding tax support of health care:
• Allow small business owners & the self-employed to have the same deductibility for health costs
• Expand eligibility for tax-free medical savings accounts
• Establish limits on the amount of damages awarded in medical malpractice lawsuits.

Allow appealing HMO decisions externally & in court

Voted YES on regulating tobacco as a drug.

Opponent's argument to vote No:Rep. HEATH SHULER (D, NC-11): Putting a dangerous, overworked FDA in charge of tobacco is a threat to public safety. Last year, the FDA commissioner testified that he had serious concerns that this bill could undermine the public health role of the FDA. And the FDA Science Board said the FDA's inability to keep up with scientific advancements means that Americans' lives will be at risk.

Proponent's argument to vote Yes: Rep. HENRY WAXMAN (D, CA-30): The bill before us, the Waxman-Platts bill, has been carefully crafted over more than a decade, in close consultation with the public health community. It's been endorsed by over 1,000 different public health, scientific, medical, faith, and community organizations.

Sen. HARRY REID (D, NV): Yesterday, 3,500 children who had never smoked before tried their first cigarette. For some, it will also be their last cigarette but certainly not all. If you think 3,500 is a scary number, how about 3.5 million. That is a pretty scary number. That is how many American high school kids smoke--3.5 million. Nearly all of them aren't old enough to buy cigarettes. It means we have as many boys and girls smoking as are participating in athletics in high schools. We have as many as are playing football, basketball, track and field, and baseball combined.

Voted NO on expanding the Children's Health Insurance Program.

• Reauthorizes State Children's Health Insurance Program (SCHIP) through FY2013 at increased levels.
• Gives states the option to cover targeted low-income pregnant women
• Phases out coverage for nonpregnant childless adults.

Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.

Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7): This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.

Voted NO on expanding enrollment period for Medicare Part D.

Voted YES on increasing Medicaid rebate for producing generics.

Voted YES on negotiating bulk purchases for Medicare prescription drug.

Voted NO on $40 billion per year for limited Medicare prescription drug benefit.

Voted YES on allowing reimportation of Rx drugs from Canada.

Voted YES on allowing patients to sue HMOs & collect punitive damages.

Voted YES on funding GOP version of Medicare prescription drug benefit.

Voted NO on including prescription drugs under Medicare.

Voted YES on limiting self-employment health deduction.

Voted YES on increasing tobacco restrictions.

Voted NO on Medicare means-testing.

Voted NO on blocking medical savings acounts.

Tax credits for those without employee health insurance.

H.R. 1181 the Health Insurance Affordability and Equity Act
With 40 million Americans currently living without health insurance, Republican Main Street Partnership members have been leading the effort to find new and innovative ways to secure health care for our citizens. Easing the burden on businesses entering into insurance purchasing pools, and expanding the use of medical savings accounts (MSAs) have been included in previous economic stimulus packages. RMSP Congresswoman Nancy Johnson (CT) in conjunction with Representatives Jo Ann Emerson (MO), Melissa Hart (PA), Jim Kolbe (AZ), Connie Morella (MD), Doug Ose (CA), Marge Roukema (NJ), Rob Simmons (CT), Fred Upton (MI), and Jim Walsh (NY) introduced legislation that targets tax credits to those that are not offered employee provided health insurance, or are self employed.

Tax deduction for long-term care insurance.

H.R. 831/S. 621 the Long Term Care and Retirement Security Act.
Republican Main Street Partnership Senators Lincoln Chafee (RI), Susan Collins (ME), and Gordon Smith (OR) joined House of Representatives sponsors Reps. Charlie Bass (NH), Dave Camp (MI), Tom Davis (VA), Greg Ganske (IA), Ben Gilman (NY), Dave Hobson (OH), Steve Horn (CA), Nancy Johnson (CT), Sue Kelly (NY), Ray LaHood (IL), Connie Morella (MD), Deborah Pryce (OH), Jim Ramstad (MN), and Rob Simmons (CT) in securing health insurance for seniors and those in long-term care facilities. As new medicines and healthier lifestyles are extending life, more and more Americans need to prepare for their long-term health needs. This legislation allows a tax deduction on long-term care insurance premiums for taxpayers, including accelerated deductions persons for people 55 years of age and up.

Support telemedicine for underserved areas.

H.R. 2706, The Medicare Telehealth Validation (MTV) Act.
Republican Main Street Partnership members Congressman Doug Ose (CA) and Jo Ann Emerson (MO) have introduced this bill to increase the use of telehealth services under the Medicare program. Currently, telehealth services are restricted to use in certain geographically underserved areas. The MTV Act provides sufficient funding and regulatory relief to expand high technology medical diagnostic tools, across the Internet, to urban as well as rural underserved areas. The bill further provides for expansion of store-and-forward techniques, and for a study of the restrictions on telemedicine due to state licensing rules.

$350 billion for prescriptions for poor seniors.

Medicare Prescription Drug Benefit
One of issues to be addressed this year by Congress is that of providing a prescription drug benefit to our nation's Medicare beneficiaries. Legislation currently being drafted [by Republican Main Street Partnership members] intends to authorize $350 billion over the next 10 years to provide purchasing assistance for prescription medications. The benefit reaches out to low and moderate income seniors by extending coverage to incomes up to 150% of the poverty level. The bill could also include provisions to correct reimbursement reductions for physicians, nurses, hospitals, technicians, home health care providers, and long-term care facilities.

Rated 25% by APHA, indicating a anti-public health voting record.

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.