Hillary Clinton
Campaign website: http://www.hillaryclinton.com/feature/healthcareplan/
Institute of Medicine health care reform principles necessary for the foundation of a just health care system (IOM 2004, http://www.iom.edu/CMS/3809/4660/17632.aspx):
1. Health care coverage should be universal.
Grade B: The Clinton plan includes an individual mandate, requiring all citizens to obtain coverage. This plan includes the creation of a new public health insurance plan with guaranteed eligibility. Private plans must also offer coverage to anyone who applies and pays their premium, regardless of any preexisting medical condition. Large employers must either offer health insurance to employees or pay into a fund to support the new public plan. Small businesses will receive a tax credit to provide health insurance. The Clinton plan gets a B because it will cover nearly all American citizens, but does not specify if it will also cover undocumented persons and permanent residents.
2. Health care coverage should be continuous.
Grade B: The new public health insurance plan is described as portable but no specifics are mentioned. The Clinton plan requires insurers to automatically renew health insurance policies if the enrollee wishes to stay in the plan. The plan gets a B rather than an A because it doesn't describe how individuals insured through their employer would be continuously insured if they lost or changed their job.
3. Health care coverage should be affordable to individuals and families.
Grade P: The Clinton plan will offer refundable tax credits linked to family income (but doesn't specify how much) and tax credits against catastrophic costs for retiree health plans. Tax credits will also assure that premiums never rise above a certain (but unspecified) percentage of family income. This plan requires insurers to apply community rating to the amount charged for premiums meaning that they cannot charge large premium differences based on age, gender or occupation. The plan receives a passing grade rather than an honors grade because it lacks the details on the maximum percentage of family income that could be spent for premiums.
4. The health insurance strategy should be affordable and sustainable for society.
Grade C: The Clinton plan would reduce administrative costs by curtailing insurance plan underwriting by requiring guaranteed issue, automatic renewal, and requiring a minimum benefit pay-out. Additional cost savings will come from information technology, preventive medicine, chronic disease management, and promoting best practices. The Clinton plan will end subsidies for Medicare Advantage plans and allow Medicare to negotiate prescription drug prices. This plan will require insurers to pay out at least 85% of premiums to provide health care rather than fund administrative expenses. Large employers must contribute to a fund or offer insurance. This plan caps income tax exclusion of employer contributions for health benefits for upper income households. Medicare reimbursement will be aligned with performance. The plan received a C because the cost-cutting mechanisms are unlikely to reduce overall administrative costs to less than 10%, the system is loosely integrated and is unlikely to substantially increase the use of cost-effective services.
Grade B: The Clinton plan promotes health information technology, requires coverage of preventive care, promotes chronic care management programs, funds a new Best Practices Institute to partner with AHRQ and the private sector to conduct effectiveness research and disseminate that information to physicians and patients. The Clinton plan supports the National Medical Error Disclosure and Compensation Act, which encourages disclosure of medical errors and negotiation with patients for fair compensation. The plan received a B because it offered a fairly comprehensive range of benefits for plans offered through the purchasing pool, but it did not offer ways to change the medical liability system to promote patient safety.
Click here to return to Report Card