Clinton Releases More Ideas to Decrease Consumer Health Care Costs

While Clin­ton’s pro­pos­als are aimed at as­suaging voters’ con­cerns about rising premi­ums and high de­duct­ibles, they are cer­tain to draw fierce cri­ti­cism from the in­dustry groups that Clin­ton’s plans tar­get.

The plan re­quires the three pre-de­duct­ible sick vis­its to be provided by in­surers and em­ploy­ers, al­though “a per­son with private cov­er­age could save over $100 per year.” And the tax cred­it—up to $5,000 per fam­ily and $2,500 per in­di­vidu­al—will be fully paid for by “de­mand­ing re­bates from drug man­u­fac­tur­ers and ask­ing the most for­tu­nate to pay their fair share.” (The cred­it would be avail­able to the in­sured whose out-of-pock­et ex­penses are more than 5 per­cent of their in­come and who are not eli­gible for Medi­care or claim­ing ex­ist­ing de­duc­tions for med­ic­al costs.)

The drug re­bates men­tioned were in­cluded in drug cost-re­lated pro­pos­als re­leased Tues­day, which were strongly cri­ti­cized by drug man­u­fac­tur­ers.

“Sec­ret­ary Clin­ton’s pro­pos­al would turn back the clock on med­ic­al in­nov­a­tion and halt pro­gress against the dis­eases that pa­tients fear most. These sweep­ing and far-reach­ing pro­pos­als would re­strict pa­tients’ ac­cess to medi­cines, res­ult in few­er new treat­ments for pa­tients, cost count­less jobs across the coun­try, and erode our na­tion’s stand­ing as the world lead­er in bio­med­ic­al in­nov­a­tion,” John J. Cas­tel­lani, Phar­ma­ceut­ic­al Re­search and Man­u­fac­tur­ers of Amer­ica’s pres­id­ent and CEO, wrote in a state­ment re­spond­ing to the pro­pos­al.

In­surers—and likely pro­viders—will also al­most cer­tainly ob­ject to her pro­pos­als, par­tic­u­larly those crack­ing down on mer­gers, which have made head­lines re­cently as ex­perts and poli­cy­makers try to de­term­ine how in­surer con­sol­id­a­tion will im­pact the health care land­scape. “Care­ful stud­ies have shown that mer­gers lead­ing to high­er mar­ket con­cen­tra­tion can raise premi­ums for con­sumers,” Clin­ton’s plan states. It gives an­ti­trust au­thor­it­ies the fund­ing to mon­it­or and in­vest­ig­ate mer­gers of both in­surers and pro­viders.

The chief ex­ec­ut­ives of both Aet­na Inc. and An­them Inc., which are seek­ing to ac­quire Hu­mana and Cigna re­spect­ively, de­fen­ded the mer­ger deals the day be­fore Clin­ton’s plans were re­leased in a Sen­ate sub­com­mit­tee hear­ing, The Wall Street Journ­al re­por­ted.

Her plan is also likely to get push­back from in­surers on its pro­pos­als to block “un­reas­on­able” health-in­sur­ance rate in­creases. Rather than cit­ing rising health care costs as the source of high­er premi­ums, Clin­ton’s plan seems to place the blame on in­surers, say­ing that al­low­ing more states to modi­fy or block rate in­creases “would help pre­vent in­sur­ance com­pan­ies from im­pos­ing ex­cess­ive, double-di­git rate in­creases without a clear jus­ti­fic­a­tion.”

Her pro­pos­al also in­cludes re­pla­cing the cur­rent fee-for-ser­vice health care mod­el with pay­ment sys­tems that re­ward value-driv­en care, a change in­cluded in the ACA.

Not­ably, Clin­ton’s plans have only in­cluded the pieces of Obama’s health care law that she would strengthen or build upon; she has yet to op­pose parts of it. In the past, she has said she would ex­am­ine the law’s “Ca­dillac” tax on be­ne­fits above a cer­tain threshold in em­ploy­er-based plans.