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Election 2016: Health Care Policy and the Presidential Campaign
My Vision for Universal, Quality, Affordable Health Care
N Engl J Med 2016; 375:e36October 27, 2016DOI: 10.1056/NEJMsb1612292
- Article
The editors invited the Democratic and Republican presidential nominees, Hillary Clinton and Donald Trump, to answer the following question for Journal readers: What specific changes in policy do you support to improve access to care, improve quality of care, and control health care costs for our nation? Secretary Clinton responded. Mr. Trump did not respond.
For my entire career, I’ve fought to provide more fairness for families and more opportunities for children, so that every child growing up in our country can reach his or her God-given potential. That’s why working to expand health care access for every American and improving the health and well-being of kids and families has been the most important cause of my life.
In the last two decades, we’ve made tremendous strides in reducing the number of uninsured people to the lowest level in history and improving health outcomes for all Americans. Because of the Affordable Care Act (ACA), 20 million more Americans have health insurance and more than 8 million kids receive health coverage each year as a result of the Children’s Health Insurance Program. As a result of the ACA, around 3 million African Americans and 4 million Hispanic Americans have gained coverage. What’s more, expanded consumer protections and access to free preventive services — like vaccinations and cancer screenings — mean all Americans now have stronger, better health coverage.
Despite this progress, we still have real challenges ahead. Americans face rising out-of-pocket costs and a health care system that is too fragmented. We need to make health coverage affordable so people can access the care they need. We need to do more to break down barriers and achieve health equity across our communities. We need to expand Medicaid in every state so that everyone has access to care, regardless of their income and where they reside. And we need to devote more resources to the necessary scientific research into the diseases of our time.
As President, I will fight for every American to have access to affordable, quality health care — regardless of their ZIP Code, income, or medical history. Health care should be a right, not a privilege.
To achieve this, I believe we need to accomplish four big goals.
I. Improve — Not Repeal — the Affordable Care Act
By securing new coverage for millions of previously uninsured people and providing peace of mind, the Affordable Care Act is an essential step toward universal health care. In fact, just this month, new Census data shows that for the first time in our history, fewer than 10% of Americans lack health insurance.
We cannot let opponents of the ACA bring us back to the days when people with chronic illnesses or disabilities were denied care, and women were charged more than men. But we must also improve the law to address the challenges it faces — just as we have done with every major piece of legislation in our nation’s history.
The ACA, which my opponent, Donald Trump, wants to repeal, doesn’t just expand coverage for millions of Americans who didn’t have it before. The law also offers new benefits and protections for the 150 million Americans with employer-based coverage. It eliminated preexisting condition exclusions for as many as 129 million people, guaranteed a new insurance option for young adults up to age 26 on their parents’ policy, prevented annual and lifetime limits for as many as 105 million Americans, and required insurers to use at least 80% of premium dollars for care — not profits — as well as covered millions of previously uninsured Americans.
My opponent and Republicans in Congress would strip away essential consumer protections and subject Americans to medical underwriting discrimination and even higher, more unpredictable premiums. They would also leave more than 20 million Americans without any insurance at all, shifting the cost of their care to insured Americans and health care providers.
Instead of repealing the ACA, my plan will build on its progress. We must work to expand Medicaid coverage in the 19 states that have left 3 million Americans without health insurance because their states refused to expand Medicaid and enroll people eligible for coverage. We need to improve and strengthen the ACA through enhanced tax credits to make coverage affordable, implementation of strong measures to bring down the cost of prescription drugs, increased competition between insurers, and an aggressive campaign to increase outreach and enrollment. And finally, we need to ensure the availability of a public option choice in every state, and let Americans over 55 buy in to Medicare. Taken together, these policies will increase competition, choice, affordability and the number of Americans with insurance.
II. Ensure Greater Affordability for All Americans
American families are being squeezed by health costs that are rising faster than wages. Too much of their hard-earned take-home pay goes to paying deductibles, copays, and coinsurance for medical expenses. In fact, the average deductible for employer coverage has growth seven times faster than workers’ wages since 2010.
To fully address this problem, we need to combat the rising overall costs of health care that workers and older Americans see reflected in their premiums, particularly ever-increasing prescription drug costs.
My plan will address both of these core issues.
First, to immediately relieve Americans of health cost burdens, I will extend a refundable tax credit of up to $5,000 per family for excessive out-of-pocket health costs. And I will impose a requirement on all insurers to limit out-of-pocket prescription drug costs to $250 a month on covered medications.
Second, to directly address rising prescription drug costs, I will work to remove barriers to competition by streamlining approval of high-quality biosimilar and generic drugs. That includes proposals to ensure that drug companies justify their prices, eliminate “pay to delay” practices, and allow Medicare to directly negotiate for better prices. I will also create a new Federal consumer response team charged with identifying excessive price spikes in long-standing, life-saving treatments, and give them effective new tools to respond.
Third, I will aggressively weed out fraud, waste, and abuse in any federally subsidized program by incorporating nonpartisan ideas from such expert groups as the Medicare Payment Advisory Commission (MedPAC). I will make sure we incentivize reporting any practices that undermine confidence in programs and increase costs.
III. Achieve Improved Health and Health Care in an Integrated Fashion
I will work to integrate our fragmented health care delivery system with reforms that reward value and quality. To do so, we must promote a health care system that treats the whole patient (mind and body), enables providers to deliver the best possible care, and reaches every American community.
To achieve this vision, we need to move forward in several areas.
Incorporating the first-hand knowledge and experience of providers, we need to streamline and enhance the policies of private and public payers to move our health care system toward practices that reward high-quality, patient-centered care, improve outcomes, and reduce costs.
We need to address the lack of access to primary health care, dental care, and mental health care by catalyzing partnerships between public health departments, health care systems, and community-based organizations. As we do, we must promote integrated mental health care, and enforce insurance coverage parity requirements to ensure that mental health care is not siloed.
My vision includes a major new commitment to community and mental health centers as well as the National Health Service Corps. This will improve our ability to respond to public health emergencies — from natural disasters, to issues of environmental justice like Flint, to escalating rates of addiction and obesity, to infectious diseases like Ebola and Zika.
We must ensure that women’s personal health decisions are made by a woman, her family, and her faith, with the counsel of her doctor. That’s why I will fight back against attempts to restrict access to quality, affordable reproductive health care, and defend access to affordable contraception, preventive care, and safe and legal abortion — not just in principle, but in practice.
And finally, we need to recognize that our health care providers are always on the leading edge of caring for Americans. So I will advocate for reforms that help doctors, nurses, and other caregivers spend more time with their patients, and lead our health care system into the future.
IV. Secure True Innovations in Diagnosing, Treating, and Curing Disease
By not investing in basic research, we’ve unnecessarily constrained our progress in addressing the diseases of both today and tomorrow. Encouraging the next generation of health innovation and entrepreneurship will help Americans lead longer, healthier lives.
I will work to ensure that our scientific community and regulatory system are promoting innovation and will increase funding for biomedical research across all diseases, including specific investments for research into diseases like Alzheimer’s and HIV/AIDS. And we must maintain a continued commitment to the cancer moon shot so we can provide health care providers with new tools and treatments for their patients.
I am also committed to expanding access to high-quality data on cost, care quality, and health delivery system performance to help patients and doctors make informed choices, and entrepreneurs build new products and services. More available information — with careful protections for privacy and security — will make our markets more efficient and transparent.
Conclusion
Health and health care in America should not be a partisan or divisive issue. As President, I will work tirelessly with anyone dedicated to improving our families’ health and ensuring that the promise of affordable, quality health care is achieved for all Americans.
This article was published on September 28, 2016, at NEJM.org.
- Citing Articles (1)
Citing Articles
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(2016) Hillary Clinton's vision for universal affordable healthcare. PharmacoEconomics & Outcomes News 763:1, 4-4.
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