John Edwards has fought special interest groups his entire career and knows that we need a health care system that works for everyone. His health plan will reform the health insurance industry to help us all get the insurance we need. Today, he proposed new laws to prevent abuses, stronger enforcement of insurance rules, and more competition and choice in insurance markets. Americans will no longer be on their own against insurance companies.

Tough New Insurance Laws:

• Insurance that Is Always There: John Edwards will stop insurance industry "rescissions," the practice of dropping individuals from insurance for technical reasons after they need their coverage. Edwards will pass a guaranteed issue law requiring insurance companies to sell insurance to everyone, regardless of their preexisting conditions, and preventing from denying coverage after a condition develops.
• A Fair Price for Good Insurance: Today, insurance companies will charge certain occupations and individuals with preexisting conditions more for insurance, such as police officers, firefighters, and construction workers. Edwards will put a stop to this practice, requiring community rating so that all people have access to insurance at a fair price.
• Ensure that Premiums Help Patients: Enacting health care reform to expand insurance to all families also requires establishing new rules so insurance companies cannot continue charging hardworking families excessive premiums, while pocketing the savings. Edwards will require insurers to spend at least 85 percent of their premiums on patient care as several states already do. The plan will force insurers to cut wasteful spending and pass savings on to families and employers.
• Empower Consumers: John Edwards will remove the mystery in what insurance companies cover. New "truth-in-insuring" rules will require insurance companies to be transparent and honest about what they will ultimately cover. The rules will set standards on explaining private insurance products and understandable medical bills.
• Guaranteed Comprehensive Benefits: Some states mandate that insurance companies must provide benefits like preventive care to children and screening tests like mammograms. Some insurance companies leave out these common-sense procedures. Under the Edwards plan, every American will have comprehensive benefits including preventive care and important tests.
• Creating a Bill of Rights for Patients and Providers: Now more than ever, Americans need a Patients' Bill of Rights for insurance and managed care companies. In 2001, John Edwards fought for the original Bill of Rights, which passed the Senate but was eventually blocked by insurance company lobbyists. As president, Edwards will help create an updated Bill of Rights to solidify the protections discussed in 2001 and reflect today's need to reform insurance companies' practices.

It is also time to protect doctors and hospitals from insurance company abuses. By making it difficult for health care providers to collect on their claims, insurance companies make it difficult for patients to get the care they need. Complex forms, long hold times on the phone, and inappropriate denials of payment for needed treatments are just some of the insurance company tactics. Edwards will develop strict rules for insurance companies that will make it easier for doctors and hospitals to get paid for and deliver needed care.

Stronger Enforcement:

• Maintaining Accountability: All Americans need and deserve a strong line of protection against insurance companies. Edwards will revolutionize the individual and small group insurance markets with his new Health Care Markets, which will negotiate plans and carefully enforce protections for families. Edwards will also ask the Department of Justice and work with states to oversee insurance markets.
• Create an Advocate for Patients: In California, when a patient has a dispute with a managed care company, the state reviews the case to make sure the company acted within the law. Every patient deserves an advocate when he or she needs it. Edwards will look to models like California's and build a national resource for regular people to get the help they need in negotiating with for insurance companies and HMOs. Edwards will also establish a medical home forAmericans with chronic diseases, giving patients a primary care doctor who can advocate against insurance companies for needed care.

More Competition

• Stop Insurance Company Monopolies: Edwards will apply rigorous standards and block mergers that could hurt consumers, doctors and hospitals. He will direct the U.S. Department of Justice to conduct an immediate and comprehensive review of the health insurance market and make recommendations on how to ensure a competitive market. Where monopolies already exist, he would break them up to ensure competition. He will also revisit the insurance company exception to the nation's antitrust laws.
• New Competition for Private Insurers: The Edwards plan creates new choices for American families. The new Health Care Markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers who choose to join rather than offer their own insurance plans. Families and individuals will choose the plan that works best for them. The markets will include a new public plan similar to Medicare. If enough people choose the public plan, then the US will evolvetowards a single-payer plan. As a result, private insurers will face new rules and competitive pressures to hold down their costs and deliver better coverage.