Posted on September 17, 2007

Hillary Clinton's "American Health Choices Plan"


The American Health Choices Plan: Ensuring Affordable, Quality, Health Care for All Americans

Hillary for President
September 17, 2007

Today, Hillary Clinton unveiled the third part of her plan to ensure that all Americans have affordable, quality health insurance. Her American Health Choices Plan covers every American — finally addressing the needs of the 47 million uninsured and the tens of millions of workers with coverage who fear they could be one pink slip away from losing their health coverage.

Providing a Choice of Insurance Plans

The American Health Choices Plan preserves existing health insurance and offers new choices to those with insurance and to the 47 million people in the United States without insurance. It ensures portability so that Americans do not lose coverage when they change or lose their jobs. Americans will have three options:

1) Keep Current Health Care Coverage: Americans who are satisfied with the coverage they have today can keep it.

2) A Choice of Health Plan Options: Businesses, employees, and the uninsured will have the option of buying group insurance through a new Health Choices Menu. This Menu will give all Americans the same set of insurance options that their Member of Congress has. Without creating new bureaucracy, the Menu will be part of the Federal Employee Health Benefit Program (FEHBP), which includes numerous, high-quality private health insurance options.

3) A Choice of a Public Plan Option: In addition to the array of private insurance choices offered, the Health Choices Menu will also provide Americans with a choice of a public plan option, which could be modeled on the traditional Medicare program, but would cover the same benefits as guaranteed in private plan options in the Health Choices Menu without creating a new bureaucracy. The alternative will compete on a level playing field with traditional private insurance plans.

Promoting Shared Responsibility

Hillary Clinton’s American Health Choices Plan is based on the principle of shared responsibility. This plan ensures that all who benefit from the system contribute to its financing and management. Specifically, responsibilities include:

Insurance and drug companies: For insurers, to end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; and for drug companies, to offer fair prices and accurate information;

Individuals: To get and keep insurance in a system where insurance is affordable and accessible;

Providers: To work collaboratively to provide high-quality care;

Employers: To contribute to health coverage, with large firms required to provide health insurance or contribute to the cost of the system, and small businesses offered tax incentives to continue or begin to offer coverage;

Government: To ensure that health insurance is always affordable through investments in tax credits and the safety net so that coverage is never again a crushing financial burden; to improve the quality performance of the system; and to end the upward cost spiral of the system that threatens our health and economy.

Ensuring Affordable Health Coverage for All

1) Ensuring Premium Affordability Through Refundable Tax Credits

2) Limiting Premium Payments to a Percentage of Income

3) Promoting Shared Responsibility for Large Employers

4) Creating Small Business Tax Credit

5) Strengthening Medicaid and the State Children’s Health Insurance Program to Serve All Low-Income Individuals

6) Creating a Retiree Health Legacy Initiative


By Don McCanne, MD

Hillary Clinton’s proposal “preserves existing health insurance,” and includes the responsibility of individuals “to get and keep insurance” through the current private insurance market, or through a “Health Choices Menu” of private FEHBP-type plans, or through a Medicare-type public program.

Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.

To make the plans affordable for individuals, she would use a combination of refundable tax credits and a cap on premiums at a percentage of income. Assuming that the plans would provide adequate benefits and adequate protection against financial hardship, the increased spending through the tax system would be exponentially more than the estimates in her plan. And most of the proposed savings to pay for these increases are largely nebulous, and some of those measures would actually increase costs.

Further, the administrative complexities of refundable tax credits and means-tested premium caps would still leave many without coverage. Coverage will never be universal unless it is truly automatic for everyone.

If we are going to use the tax system to pay for health care anyway then why should we waste funds on the profoundly inefficient system of segregated private health plans? A universal risk pool that is equitably funded through the tax system is the most efficient and least expensive method of ensuring comprehensive coverage for everyone.

Many will try to contrast the differences in the Clinton, Obama and Edwards proposals, but they are all basically the same. In spite of their rhetoric, they have each made the protection and enhancement of the private insurance plans a higher priority than patients.