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September 17, 2007

The "America's Choices" Plan

The short answer: Her plan is very, very good. Indeed, it's very similar to Edwards' plan. I'll have more as I'm able to process its chunks and get clarification on certain points, but here's the campaign's official rundown:

1. Offer New Coverage Choices for the Insured and Uninsured: The American Health Choices Plan gives Americans the choice to preserve their existing coverage, while offering new choices to those with insurance, to the 47 million people in the United States without insurance, and the tens of millions more at risk of losing coverage.

· The Same Choice of Health Plan Options that Members of Congress Receive: Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.

· A Guarantee of Quality Coverage: The new array of choices offered in the Menu will provide benefits at least as good as the typical plan offered to Members of Congress, which includes mental health parity and usually dental coverage.

2. Lower Premiums and Increase Security: Americans who are satisfied with the coverage they have today can keep it, while benefiting from lower premiums and higher quality.

· Reducing Costs: By removing hidden taxes, stressing prevention and a focus on efficiency and modernization, the plan will improve quality and lower costs.

· Strengthening Security: The plan ensures that job loss or family illnesses will never lead to a loss of coverage or exorbitant costs.

· End to Unfair Health Insurance Discrimination: By creating a level-playing field of insurance rules across states and markets, the plan ensures that no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums.

3. Promote Shared Responsibility: Relying on consumers or the government alone to fix the system has unintended consequences, like scaled-back coverage or limited choices. This plan ensures that all who benefit from the system share in the responsibility to fix its shortcomings.

· Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information.

· Individuals: will be responsible for getting and keeping insurance in a system where insurance is affordable and accessible.

· Providers: will work collaboratively with patients and businesses to deliver high-quality, affordable care.

· Employers: will help finance the system; large employers will be expected to provide health insurance or contribute to the cost of coverage; small businesses will receive a tax credit to continue or begin to offer coverage.

· Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.

4. Ensure Affordable Health Coverage for All: Senator Clinton's plan will:

· Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage.

· Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.

· Create a New Small Business Tax Credit: To make it easier--not harder--for small businesses to create new jobs with health coverage, a new health care tax credit for small businesses will provide an incentive for job-based coverage.

· Strengthen Medicaid and SCHIP: The Plan will fix the holes in the safety net to ensure that the most vulnerable populations receive affordable, quality care.

· Launch a Retiree Health Legacy Initiative: A new tax credit for qualifying private and public retiree health plans will offset a significant portion of catastrophic expenditures, so long as savings are dedicated to workers and competitiveness.

5. A Fiscally Responsible Plan that Honors our Priorities:

· Most Savings Come Through Lowering Spending Due to Quality and Modernization: Over half the savings come from the public savings generated from Hillary Clinton's broader agenda to modernize the heath systems and reduce wasteful health spending.

· A Net Tax Cut for American Taxpayers: The plan offers tens of millions of Americans a new tax credit to make premiums affordable--which more than offsets the increased revenues from the Plan's provisions to limit the employer tax exclusion for healthcare and discontinue portions of the Bush tax cuts for those making over $250,000. Thus, the plan provides a net tax cut for American taxpayers.

· Making the Employer Tax Exclusion for Healthcare Fairer: The plan protects the current exclusion from taxes of employer-provided health premiums, but limits the exclusion for the high-end portion of very generous plans for those making over $250,000.

September 17, 2007 | Permalink

Comments

Too early to say more than there's some good sense and good politics in the outline of the plan - but as always, details will matter on nearly every point.

They key issue is whether corporate and small biz employers will see this as an overall gain for them - and either support this kind of approach, or remain neutral (very likely to happen).

The GOP will go ape-shit, of course, on any plan she proposes. If the health insurance and drug industries also go ape-shit, then monumental amounts of money will be spent in opposition. Watching their reaction will be interesting.

As to cost, the handwaving is there, but a very detailed analysis by several credible actors is important. The US is quite likely to be in recession by 2009/10, and the pressure of federal budget deficits will be obvious. If the costs of the Iraq/Afganistan war continue to be high and unfunded in the budget (as currently), it will be very hard to come close to budget neutrality (pay/go). This wider concern over the US economy and federal spending will color nearly everything the Dems propose to do if they win.

Are there any indications floating around DC about when/if Hillary will provide a detailed supporting plan?

Posted by: JimPortlandOR | Sep 17, 2007 12:20:13 PM

it will be curious to see whether the narrative is just her plan or the fact it mirrors edwards. pointing to edwards leading the way. i doubt this will happen.

Posted by: akaison | Sep 17, 2007 12:22:21 PM

Ezra,

Something that needs some clarifying from the plan from someone who has the time/job description to do some reporting on the issue-- page 6:

Creating a Retiree Health Legacy Initiative: For major American employers with
workforces that face unusually high health care costs due to a high ratio of retirees, health
care costs can be a drag on competitiveness and job creation – particularly for our major
manufacturers. The American Health Choices Plan will provide a tax credit for qualifying
private and public retiree health plans to offset a significant portion of catastrophic
expenditures that exceed a certain threshold.

This appears to be a hand-out to overstretched companies that have offered generous health care benefits to retirees. This isn't really explained much further than what's above-- is this what's being offered for industry to play ball with HRC's plan?

Can you find out exactly what this is, who qualifies and what the cost (lost government revenue in tax credits) would be?

Posted by: wisewon | Sep 17, 2007 12:31:22 PM

Methinks that all the insurance money donated to Hillary over the last few years will be coming back as dividends:
mandatory private insurance for every american - wee!

just expand medicare to include everyone - what's the damn problem?

for-profit insurance companies are the problem and shouldn't be part of the solution.

Posted by: Whatever | Sep 17, 2007 12:34:13 PM

I agree with:

"it's very similar to Edwards' plan."

In broad brush stokes...it has similarities, but the devil is in the detail...and since Hillary's involved they be some devilish details. However, I am happy Edwards is showing Clinton the way. If Clinton/Obama would just follow Edwards on other issues [thinking Iraq here], we may have made Democratic candidates out of the press anointed front runnersfor the Democratic party.

Not that I think Clinton/Obama won't renounce much of the progressive label once their in the presidency...after all, they certainly have that history in the Senate.

It's kinda of sad that the media spends so much time trashing Edwards that he really doesn't have a chance, but if he can get Clinton and Obama to voice his policies it will make it harder for Obama & Clinton to renounce progressive policies once their in office

You gotta feel bad for Dodd though, he has similar policies to Edwards, but the press doesn't feel he is worth their time, so they don't do a number on him like they did on Edwards. That's got to hurt, not good enough to be trashed by our poodle press.

Posted by: S Brennan | Sep 17, 2007 12:47:08 PM

You know this insurance bashing thing is really just blind arguing. Just because these insurance companies in the US are horrible does not mean that they are horrible in every instance.

The French health care system has roughly the same number of people on private insurance as the US does.

Still the number one system in the world.

The most important aspect of health insurance isn't a populist move to destroy an evil business.

Posted by: Phil | Sep 17, 2007 1:06:10 PM

This plan reminds me a lot of Bush's tax refunds. Those who most needed a break got little in tax refunds, or in the case of some who have such low incomes as to have no taxes due, those very needy people got no tax refund at all. I wonder how those very low income folks who pay very little or no tax could ever make use of a 'tax credit' for health insurance? This plan is designed to benefit those already better off financially. Once again, the working poor are left out, unless they want to give up their dignity and apply for welfare.

Posted by: Donna | Sep 17, 2007 1:06:42 PM

Am I misreading this, or is there no public health insurance component (and therefore no pathway to single payer)?

Posted by: Omar | Sep 17, 2007 1:23:48 PM

Yes, Everyone knows that forcing the poorest Americans into health insurance programs that they can't afford and that won't ever pay out the benefits they promise is the start of a truly great health care proposal.

this is just another way for hillary Clinton's corrupt, plutocratic ass to funnel money into her corporate campaign contributers pockets through tax breaks that most americans will never know how to claim when they file.

This is what I mean when I say Ezra goes out of his way to pretend that Hillary's proposals are more progressive than they really are.

Posted by: soullite | Sep 17, 2007 1:27:07 PM

OMar, you read it right. It's just a huge giveaway for 'managed' care and corporations that buy fake insurance policies. This is more or less what youd expect from Hillary Clinton.

Posted by: soullite | Sep 17, 2007 1:28:56 PM

Phil. This is America, it's not France. We do not have the regulatory state to make private health insurance work, nor does our business culture have anything like France's commitment to the public good.

Posted by: soullite | Sep 17, 2007 1:30:42 PM

Phil. This is America, it's not France. We do not have the regulatory state to make private health insurance work, nor does our business culture have anything like France's commitment to the public good.

Her plan clearly calls for heavy regulation of the insurance industry, or at least fair regulation of the insurance industry.


Also her plan clearly gives people a medicaid like alternative to public insurance.

If someone prefers a private insurance policy to a medicare insurance policy thats their right.

Posted by: Phil | Sep 17, 2007 1:35:42 PM

A very detailed and comprehensive plan from Hillary. And she will deliver as promised. Bravo.

Posted by: Theresa McDonald | Sep 17, 2007 2:04:45 PM

Are we back?

For-profit insurance is part of the problem. Hillary thinks Big Insurance will play nice, and they've helped bankroll her career ever since they showed her who's boss. Well, fuck that shit.

The stuff on denial of coverage (and more significantly, denial of reimbursement) is very weak.

Posted by: pseudonymous in nc | Sep 17, 2007 2:07:55 PM

I see the Hillary bots have shown up. Hello Theresa.

Posted by: akaison | Sep 17, 2007 2:08:03 PM

Not quite.

Posted by: pseudonymous in nc | Sep 17, 2007 2:10:58 PM

First of all let's get our timeline straight. Edwards plan was taken in large part from Clinton's plan 15 YEARS ago. What Clinton is proposing is a new and improved version of her original plan. Take time out to review it and you will see that the Edwards plan is essentially Hillary lite. Let's keep it real folks.

Posted by: Wizzard | Sep 17, 2007 2:44:33 PM

As for a public component, there will be the ability to buy into the health plan that our congress critters use--so if everyone likes that one and starts buying that plan, then that's a pathway to single payer. Not that this is the intent behind the plan.

As for what poor/working class folks have, the tax credit is REFUNDABLE which means you get $$ back on your taxes. Only if you're unwilling to file taxes would you not get the money for the insurance program. And if you're working poor, then there are several tax credits you'd be missing out on in that case.

Posted by: Sarah in TX | Sep 17, 2007 2:51:01 PM

"As for what poor/working class folks have, the tax credit is REFUNDABLE which means you get $$ back on your taxes"

UNless the purchase is subsuiduzed, then this does jack for people already living payceck to paycheck without helath insurance. If you dopn't have the money now, you won't have it when this plan goes into effect.

Posted by: Kevin | Sep 17, 2007 3:20:00 PM

and now we have the second wave. confuse the issue by talking about hillarycare in 1992 which by the way DOES NOT resemble either was hillary is proposing now or what Edwards proposed before her. But to do what this plan requires- namely neutralize the Edwards threat- we must watch as they muddy the waters, even if its with lies. again, y'all learned the wrong things from rove. you may win this election, but you will have hurt the party as much as bush hurt his.

Posted by: akaison | Sep 17, 2007 3:46:30 PM

"Very, very good"? No way. Where is the money going to come from to avoid burdening moderate income Americans with premiums they can't afford or sticking them with insurance in name only that doesn't provide decent coverage of medical costs? Why guarantee America's health system will be 15% more expensive than it needs to be by keeping insurance companies in the picture? Why buy into the nonsense about individual responsiblity? Health care should be one of many socially guaranteed economic rights, financed through progressive taxes. Hillary's plan falls so far short of this ideal that it can best be described as barely mediocre. (To be fair, the plans put forward by Edwards and Obama aren't much better.)

Posted by: Randy Silverman | Sep 17, 2007 4:12:31 PM

"Very, very good"? No way. Where is the money going to come from to avoid burdening moderate income Americans with premiums they can't afford or sticking them with insurance in name only that doesn't provide decent coverage of medical costs? Why guarantee America's health system will be 15% more expensive than it needs to be by keeping insurance companies in the picture? Why buy into the nonsense about individual responsiblity? Health care should be one of many socially guaranteed economic rights, financed through progressive taxes. Hillary's plan falls so far short of this ideal that it can best be described as barely mediocre. (To be fair, the plans put forward by Edwards and Obama aren't much better.)

Posted by: Randy Silverman | Sep 17, 2007 4:13:34 PM

"Very, very good"? No way. Where is the money going to come from to avoid burdening moderate income Americans with premiums they can't afford or sticking them with insurance in name only that doesn't provide decent coverage of medical costs? Why guarantee America's health system will be 15% more expensive than it needs to be by keeping insurance companies in the picture? Why buy into the nonsense about individual responsiblity? Health care should be one of many socially guaranteed economic rights, financed through progressive taxes. Hillary's plan falls so far short of this ideal that it can best be described as barely mediocre. (To be fair, the plans put forward by Edwards and Obama aren't much better.)

Posted by: Randy Silverman | Sep 17, 2007 4:15:46 PM

It's like car insurance; buy it or go to jail... your choice, sort of. Welcome to www.HillaryCare.us!

Posted by: Steve | Sep 17, 2007 5:54:23 PM

See if you can spot the Hillary Lie:

American Health Choices Plan gives Americans the choice... to the 47 million people in the United States without insurance

Millions of those 47 million are actually not Americans, with many of those being foreign citizens who are here illegally.

Since the Democratic Party strongly supports illegal immigration, it would be interesting to hear what they intend to do to avoid, for instance, Mexico sending us any more people who would then swamp our system.

I really don't expect an honest discussion of that issue, and because they won't honestly discuss the downsides of these plans no one should take anything they say seriously. Obviously, that goes for our host as well.

Posted by: TLB | Sep 17, 2007 6:30:28 PM

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