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Questions to Ask the Candidates

As part of our wish to help educate you, the consumer, through our website we have included the following questions to ask your local candidates to determine where they stand on relevant health care issues.


The Quality Gap: Medicine's Secret Killer

  1. Should health plans be required to provide an independent external appeals process when someone is denied coverage for a particular medical treatment?

  2. Would you support a mandatory reporting system in which state governments collect standardized information about adverse events that result in death or serious harm, as proposed by the Institute of Medicine.

  3. The Institute of Medicine estimates that between 44,000 and 98,000 Americans die each year as a result of medial errors and that the cost of such errors is between $17 billion and $29 billion. How would you propose we resolve this issue?

  4. Should the managed care industry monitor itself and set voluntary standards for managed care plans to follow? Should a nongovernmental independent organization develop and enforce standards that managed care plans must follow?

  5. What is the best way to ensure that consumers in HMOs and other managed care plans are treated fairly and get proper care? Should the federal or state governments — or both — develop and enforce regulations that managed care plans must follow?

  6. Would you support a patient's right to sue their health plan for medical malpractice? With what stipulations?

  7. Would you support patient protection legislation that would require HMOs to provide patients with additional information about their health care plans? Improve access to specialists? Permit appeals to be heard by independent reviewers? Give the patient the ability of holding his or her HMO legally accountable for decisions by the HMO that result in harm to the patient?

  8. How about a Patients' Bill of Rights that includes access to emergency care without pre-authorization? Direct access to specialists? Restrictions on gag clauses? Disclosure of plan benefits? Cost sharing requirements?

  9. What do think about the proposal that HMOs not be allowed to have financial incentives that reduce needed care or referrals to specialists?

  10. Do you support a Patients' Bill of Rights?
    What are the key issues you feel should be addressed?
    • Do you agree that physicians, not a health plan, should decide medical care
    • Would you support the right for a patient to freely choose a physician?
    • Would you support the passing of a managed care law in our state?
    • Do you believe that an independent appeals process for managed care decisions is necessary?
    If yes, what would you do to ensure this occurs in our state?

  11. What do you think about the proposal by Congress that health plans be liable for health care coverage decisions made by the providers they use?

  12. Are you receiving contributions from health care "stakeholders" such as hospitals, physicians groups, a health plan or health care workers union?

  13. One way to enhance the quality of care minorities receive is to provide minority health professionals. How would you increase the number of minority health professionals in our area? How would you increase health care provider "cultural competence" or understanding of cultural backgrounds and ethnicity?

  14. How many minorities are enrolled in medical school in our state? Are our medical schools conducting special cultural competence programs? What is our state doing to encourage minorities to become health care providers?

The Chronically Ill: Pain, Profit, and Managed Care

  1. What do you propose be done for the many Americans who are caring for chronically ill family members at home?

  2. Why does our health system do better at emergency care than at caring for the chronically ill?

  3. Many people cannot qualify for private long- term care insurance, because they cannot afford it. How would you address this problem?

  4. If you had to choose which population to target for prescription drug assistance, would it be seniors or the chronically ill? Why?

  5. Some propose encouraging workers to buy private insurance to help pay for long-term care expenses, but many workers cannot afford the additional costs. What would you propose to help families that can't afford long-term care insurance?

  6. What do you think about President Clinton's proposal of a new tax credit of up to $3,000 for people needing long-term care, their spouses or caregivers?

The Uninsured: 44 Million Forgotten Americans

  1. Do the uninsured in our state have difficulty receiving health care? Where can the uninsured go to receive health care for themselves or their families? How do they find out about programs and resources? Are there outreach efforts in place? How successful are they? What means of evaluation exist for these programs?

  2. How do you propose to reduce the numbers of people without insurance in our area?

  3. Do you believe that our government should help people who do not have health insurance?
    • If yes, how would you propose this be accomplished? How much would the proposal cost, and how would it be financed?

    • If no, why? Would you support expanding public programs like Medicaid, the State Children's Health Insurance program, or Medicare?



  4. How would patients' rights legislation affect premiums and the number of uninsured people? Do you think it would increase costs for people with health insurance?

  5. Do you think employers may drop health coverage for their workers, possibly increasing the number of uninsured?

  6. Some propose encouraging workers to buy private insurance to help pay for long- term care expenses, but many cannot afford the additional costs. What would you propose to help families that can't afford long-term care insurance?

  7. Many studies show that minorities live with disproportionate sickness and diseases. Have you gauged the minority health care needs in our area?

    If so, what do you feel they are and how do you plan to meet them?

  8. Do you support tax-based incentives that would make it easier for American families to afford health insurance, such as a tax break for individuals who purchase their own health insurance?

  9. What programs would you support to keep former welfare recipients from losing their Medicaid?

  10. How would your proposals make it easier for small businesses and self-employed persons to afford health care coverage?

  11. Do you know if any small businesses in the area plan to charge their employees higher premiums to compensate for the increase in health care costs? Do you have any plans for reforms that would help small businesses get better health insurance rates?

  12. Would you support a plan to limit how much insurers can charge for policies?

  13. How will our state ensure that individuals who are eligible for Medicaid will be signed up and stay enrolled?

  14. How many workers in our state do not have access to employer-sponsored health coverage?

  15. What will your administration do to ensure that the immigrant community understands that receiving government health benefits will not label them a public charge and affect them becoming a citizen?

  16. How large is the minority population in our state? What is the number of uninsured minorities in our state? What are the main health care concerns of the minorities in our state? What are you doing to address the health care disparities that exist in our state?

  17. Do you believe we should continue with a system in which our health insurance is provided by employers?

  18. What ideas do you have for reducing the health care consumer's out-of-pocket health care costs?

  19. Would you support a cap on health insurance premiums?

CHILDREN

  1. How do you propose our state begin to combat the fact that 15.4 percent of American children are uninsured?

  2. How do you suggest we handle the problem that 29 percent of former welfare children were uninsured at least one year after leaving welfare?

  3. How active will your administration be in discovering Medicaid-eligible children and enrolling them in the State Children's Health Insurance Program (S-CHIP)?

  4. Millions of children remain uninsured despite being eligible for either Medicaid or S-CHIP. Do you know how many children, in our state, are eligible for, but not enrolled in, these programs? How will you educate families about these programs?

ELDERLY

  1. Nursing home care costs on average $56,000 per year, most of which comes out of pocket. How do you plan to address the issues concerning long-term care?

  2. What do you think about President Clinton's proposal of a new tax credit of up to $3,000 for people needing long-term care, their spouses or caregivers?

  3. If the Medicare eligibility age is increased, what do you propose to do for those who can't work past 65 due to the physical nature of their jobs?

  4. What can be done to help the new elderly with retiree benefits when employers are reducing or eliminating retiree benefits in response to increasing health care costs?

  5. President Clinton proposed a Medicare "buy-in" plan, which would support an otherwise uninsured population, allowing people 62 to 65 to pay a $300 monthly premium to receive Medicare coverage. It would also allow displaced workers 55 to 62 to buy in at a higher premium to receive coverage. Would you support such a plan?

  6. Do you favor strategies for long-term care coverage that expand public programs like Medicaid or Medicare?
    • If yes, would you favor a program that helps people regardless of income or should programs be limited to those with low incomes?
      Would the program cover nursing home care, home health care, or both?
      How should this additional cost to the government be financed?



  7. Have you signed the pledge to make long-term care a priority issue if you are elected? Would you sign such a pledge? How do you propose to reform the issue?

  8. With the projected growth of the elderly population, especially the oldest old-age 85 and older-who are most likely to need long-term care, how should we plan to provide and finance long-term care in the future?

MEDICARE:

  1. Should Medicare's eligibility age — like that for Social Security — be raised from 65 to 67?
    • If yes, are you concerned about the projected increase in the number of uninsured people?

    • If yes, would you support allowing early retirees to buy into Medicare?
      What is your view on government subsidies in this case?



  2. Should wealthier beneficiaries be asked to pay higher Medicare premiums?
    • If yes, what would be the income level for higher premiums?



  3. Should prescription drugs be added to the Medicare benefit package so that all beneficiaries have coverage for their medications? What about long-term care services? Do you think seniors should have health insurance that covers prescription drugs?

  4. Many candidates have discussed the need to eliminate waste and fraud in the Medicare program. Do you think this is a widespread problem? What more should be done to address it?

  5. What is the best way to provide:
    • Prescription drug coverage for American's seniors?

    • A Medicare expansion?

    • A program for low-income beneficiaries only?

    • An approach that encourages private insurers like Medicare HMOs and Medigap plans to offer such coverage?

    • Tax credits?

    • Why?



  6. Should the federal government help seniors with their health care costs?
    • If yes, how should the added cost to the government be financed?
      Raising premiums?
      Using the federal budget surplus?
      Establishing taxes?



  7. In 1999, there were 34 million Americans over age 65. It is estimated that by 2030, that number will double, to 68 million. This will have a powerful effect on Medicare costs. How would you propose we keep the Medicare trust fund from being depleted?

  8. How hard has our state been hit with Medicare managed care pullout? Do you support a Medicare reform plan? What do you propose?

  9. How would you recommend we alter the fact that health plans are continuing to leave the Medicare +Choice program affecting hundreds of thousands of seniors? What would you do to encourage plans to stay? What would you do to ensure equitable distribution of payment?

  10. Would you agree with creating a Medicare board that would oversee negotiations with private and government plans, enrollment processes, benefit design, and enforce standards?

  11. What percent of Medicare recipients in our state/area need assistance with their health care costs? What solution(s) do you propose for this problem?

  12. President Clinton proposed a Medicare "buy-in" plan, which would support an otherwise uninsured population, allowing people 62 to 65 to pay a $300 monthly premium to receive Medicare coverage. It would also allow displaced workers 55 to 62 to buy in at a higher premium to receive coverage. Would you support such a plan?

MARKET:

  1. Some advocate permitting early retirees to buy into Medicare. Do you support this approach?
    Should the government provide subsidies to help low-income early retiree pay their premiums?

  2. Some advocate replacing the current system, which gives employers tax incentives to provide insurance, with a new one that offers individual tax subsidies for purchasing private insurance. Do you support this approach?
    Why or why not?

  3. What do you think about the market consolidation of major health care plans that has occurred in the past few years?
    What do you propose we do about it?

Resources:

As part of a nonpartisan, public education initiative of the Henry J. Kaiser Family Foundation and the League of Women Voters Education Fund Join the Debate: Your Guide to Health Issues in the 2000 Election was developed. This beneficial publication contains key questions for citizens to ask candidates to help make informed decisions about the candidates' stands on various health care issues. To receive a copy of the publication you may contact the Kaiser publications request line at 1-800-656-4533. Or you may visit the Kaiser Family Foundation's website at www.kff.org/content/2000/1574 or the League of Women Voters Education Fund website at www.lwv.org.



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