Americans will elect a new leader in 2016, one whose presidency will make an impact on the future of the U.S. health care system. Under the Affordable Care Act, signed into law by President Obama in 2010, millions of previously uninsured or underinsured Americans have gained access to affordable coverage without having to depend on work-based options or settle for limited policies. Hillary Clinton, the presumptive Democratic nominee, has been a long-time supporter of the ACA. She intends to keep the existing law in place while making incremental changes over time to improve it.
Under Hillary Clinton’s health care plan, many of the same features and benefits that exist under the ACA will remain intact. Specifics of her proposed plan have not been released to the public, but the Clinton campaign has outlined a few noticeable changes on her official website. In this article, we offer a comparison of Hillarycare and Obamacare so that you can see what a health care system under Hillary Clinton might look like.
Primary Philosophy
According to Clinton’s campaign website, Hillary believes that affordable health care “is a basic human right.” In the past, she has supported a single-payer system whereby the government acts as the primary financier of the country’s health care. However, she has since supported the Affordable Care Act. Under her presidency, she would continue to support the current law by building on it and expanding it in certain areas. Specifically, she wants to control rising prescription drug costs, force pharmaceutical companies to spend more time on research and help women gain access to appropriate reproductive care.
It’s a well-known fact that Hillary Clinton has spent much of her political career advocating for health care issues. She was instrumental in developing the Children’s Health Insurance Program (CHIP), which currently provides health insurance to 8 million children from low-income families. Hillary’s philosophy on health care is that it should be universal and affordable. The ACA promotes the same idea.
Benefits and Coverage
The ACA guarantees coverage to those who sign up for it. This means that anyone who can enroll in a health care plan – which is the majority of the population, with very few exceptions – is guaranteed certain rights and protections under ACA-compliant policies. Among these are 10 essential health benefits. If you buy a new plan on the marketplace, via a private broker or through your employer, you’re guaranteed coverage for the following:
- Maternity care
- Pediatric care
- Hospitalizations
- Rehabilitative support
- Preventive care
- Lab tests
- Mental health care
- Outpatient services
- Emergency care
- Prescription drugs
Hillary Clinton wants to preserve these essential benefits, and she wants to improve the quality of the services that you receive from your doctors. In addition, she wants to invest more time and money into developing ways for rural communities to access better health care options, specifically through telehealth services. She has also proposed allowing people three sick visits to their doctor a year before the visits start counting toward the yearly deductible. This practice may help to offset some of the financial burden involved when seeing a doctor, which might encourage more people to use their health insurance when they need it.
Among Hillary’s chief concerns is women’s health, including reproductive health and abortion access. As president, she would remove barriers to abortion access, such as the Hyde Amendment. This amendment prohibits federal funds from being used to cover the cost of abortion unless the pregnancy is the result of rape or incest, or the mother’s life is at risk. She also supports Planned Parenthood and would defend it as president.
Under a Hillary Clinton presidency, benefits and coverage would look almost identical to how they look under the current law. She would expand some areas – like women’s health care coverage – but in essence, she supports the existing law.
Special Features
Hillary Clinton’s health care plan includes some special features that differ from or expand on the concepts introduced by the Affordable Care Act. For starters, she wants to include a “public option” on the marketplaces, an idea that was originally supposed to be included in the current law. A public option would allow people to buy into a government-run health care plan similar to the one that federal employees use. The current marketplaces are managed by state and federal governments, but they do not offer public health insurance. Only private coverage is currently available to the public.
The ACA also only allows American citizens to buy health insurance from the marketplaces. A recent bill in California would allow undocumented residents to obtain health insurance from California’s state exchange. Hillary Clinton has proposed to allow illegal immigrants throughout the country to buy health insurance from the exchanges as well. This would be a substantial change from the current law, which limits coverage to legal residents.
In an effort to make sure that everyone gets covered, Hillary also plans to spend $500 million on a more concentrated enrollment effort. According to her campaign, 16 million Americans who are eligible for coverage do not have health insurance. Despite efforts from the Obama administration to encourage enrollment over the past three years, some people still don’t understand their options or what might be available under the new law. Hillary wants to use targeted advertising, better outreach tactics and trained navigators to make enrollment easier on those who need coverage.
One of the goals of the ACA was to reduce Medicare spending. Under the current law, seniors can enroll in Medicare once they turn 65. Hillary has suggested a much younger, optional buy-in at age 55. Over time, greater participation in Medicare may help to distribute its costs more effectively for beneficiaries.
Finally, Hillary wants to increase funding for autism and Alzheimer’s disease research. She has proposed expanding insurance and access to early screening for those with autism or those who may develop autism. She has also proposed spending $2 billion a year on developing treatments for and preventing Alzheimer’s disease.
Costs: Deductibles, Copays, Premiums and Prescriptions
Cost plays the biggest role in the decision to buy health insurance, and the ACA has eliminated this barrier for millions of Americans. However, there are still many people who could have health insurance but who choose not to purchase it due to the initial cost. Hillary Clinton has proposed to make health insurance even more affordable than it already is under the ACA. She would accomplish this by:
- Putting a cap on premiums. Under Hillarycare, families who buy health insurance on the marketplaces would not spend more than 8.5 percent of their income on monthly premiums.
- Fixing the “family glitch.” The current law has a glitch that allows families to fall into a coverage gap. Essentially, if you have health insurance through your employer, your family isn’t eligible for marketplace coverage even if the employer-sponsored plan is too expensive for the rest of your family. Hillarycare would fix this glitch so that you could cover your whole family.
- Lowering drug costs. Hillary wants to lower drug costs by holding pharmaceutical companies accountable for research. She would limit the amount of profits that could be spent on direct advertising and instead require more of a percentage to be spent on research, particularly for generic options.
- Limiting out-of-pocket expenses. By allowing people to visit the doctor three times before being charged the deductible, Hillarycare would reduce out-of-pocket expenses.
- Limiting mergers between large companies. In order to ensure greater choices, Hillary Clinton wants to curb mergers between large insurance providers. She would work to limit these mergers so that Americans have more options to choose from when signing up for coverage.
Hillarycare and Obamacare share a common goal of keeping health insurance accessible as well as affordable. Her proposed changes to the existing law are incremental and designed to happen over time. In essence, Hillary wants to take the ACA to a new level in terms of affordability by making sure that everyone has access to cost-effective coverage.
Financial Assistance
Obamacare enables low- and middle-income families to purchase health insurance with the assistance of federal subsidies. These subsidies – also called tax credits – lower the cost of monthly premiums, substantially in some cases. Hillary Clinton believes that there could be even more financial assistance available. Under her plan, families would be given subsidies of up to $5,000 to help offset the cost of out-of-pocket spending and monthly premiums that exceed 5 percent of their income.
For those who can’t afford coverage, Hillary proposes expanding Medicaid even further. The Supreme Court ruled that states had the option to expand Medicaid as provided for in the Affordable Care Act. Several states have opted out of this expansion, leaving millions of low-income Americans without access to health insurance. The Obama administration currently offers 100 percent fund matching for the first three years to states that expand Medicaid. Hillary would uphold this policy. Under Hillarycare, states would also have more incentives available to expand Medicaid, such as better outreach and enrollment efforts.
By all accounts, Hillarycare would not be substantially different in terms of goals or objectives from Obamacare. Hillary wants universal health care coverage, but she does not support overhauling the existing law in favor of starting over like Republicans or her Democratic opponent Bernie Sanders. Instead, she wants to build on the current law to make it more effective and more efficient in the long run. Under Hillarycare, there would be greater financial assistance for low- to middle-income families, more funding for specific research projects and possibly more choices for buying health coverage, especially for undocumented residents and those who would prefer a public option. Hillary Clinton would retain much of the current law, revising over time as necessary.
Sources:
https://www.hillaryclinton.com/issues/health-care/
https://ballotpedia.org/Hillary_Clinton_presidential_campaign,_2016/Healthcare
http://www.nytimes.com/2016/05/11/us/politics/hillary-clinton-health-care-public-option.html?_r=0
