Hillary Clinton, Bernie Sanders and Barack Obama haven't always sung “Kumbaya” when it comes to healthcare policy. But their solo tunes mostly harmonized by the time Sanders finally endorsed Clinton for the Democratic presidential nomination last week.
To win the Vermont senator's backing, Clinton tweaked her healthcare platform to more strongly embrace a public plan option in the Affordable Care Act insurance exchanges, sharply boost funding for federally qualified community health centers and the National Health Service Corps, and allow people to voluntarily buy in to Medicare at age 55. Those proposals helped ease the sting for Sanders and his supporters resulting from the Democratic Platform Committee's decision not to advocate a government single-payer system, the emotional heart of the Sanders campaign.
Following release of Clinton's updated health platform, President Obama published a healthcare reform progress report in JAMA on July 11 recommending establishment of a “Medicare-like public plan … to compete alongside private insurers in areas of the country where competition is limited.” Adding a public plan, he argued, would strengthen the ACA markets, give consumers more affordable plan choices and save the government money.
Sanders quickly praised Clinton's healthcare agenda. “These steps will get us closer to the day where everyone in this country has access to quality, affordable healthcare,” he said. About her plan to double funding for community health centers to $40 billion over 10 years, Sanders, who long has championed these federally supported clinics for poor and uninsured people, gushed that “it will save lives. It will ease suffering. … And it will cut healthcare costs.”
The Democrats' relative unity on healthcare going into their national convention, which opens July 25, contrasts with lingering uncertainty on the Republican side about whether presumptive nominee Donald Trump will fully align himself with the recent House Republican leadership proposal to repeal and replace Obamacare, tax employer health plans, and cap and cut Medicare and Medicaid spending. Adding to the disarray, some Republicans favor keeping key parts of the ACA, including the law's Medicaid expansion and various revenue sources, to help millions of Americans stay insured.
Clinton and the Democratic National Committee say their focus is improving the functioning of the ACA markets to make premiums, out-of-pocket costs and prescription drugs more affordable. Clinton's proposal would require health plans to cover three sick visits to a doctor a year without applying the deductible; give insured people a $5,000 per family refundable tax credit for out-of-pocket costs exceeding 5% of income; bar providers and insurers from charging patients out-of-network bills for services received in an in-network hospital; and strengthen state authority to block excessive insurance premium increases.
In addition, she wants to cap Americans' out-of-pocket costs for prescription drugs, let Medicare negotiate drug prices, and allow consumers to buy lower-cost drugs from foreign countries with approved safety standards.
Clinton and Obama touted the public plan option as a way to boost competition and make the exchanges more viable. Their proposals come as 16 of the 23 not-for-profit co-op plans created by the ACA have collapsed and a number of private insurers have exited the exchanges, complaining that the customers tend to be sicker and more costly to cover than non-exchange members. These plan closures and departures have left hundreds of counties and three entire states with only one insurer selling products on the exchange.
But some observers wonder whether Clinton stepped up her support for the public option and Medicare buy-in more to placate the sizable single-payer wing of her party rather than because she seriously intends to pursue those controversial policies if she's elected. She surely has not forgotten that in 2009, the public option was so politically toxic that Democrats removed it from the ACA legislation to win passage of the law.