Hillary's Health Plan: Mandates But No Government Takeover

DES MOINES, Iowa, Sept. 18 -- Individuals would be required to buy health insurance and there would be tax credits and subsidies for those who can't afford to under Democratic presidential candidate Senator Hillary Rodham Clinton's long-awaited and ambitious plan to provide health coverage for all Americans.

Clinton proposes "shared responsibility" among patients, insurers, pharmaceutical companies, employers, health providers, and government.

Still wary after the attacks that helped defeat her husband's proposed overhaul of health care 13 years ago, the New York senator repeatedly stressed that her plan won't be a top-down, government-run program, although she expects Republican opponents to attack it as such.

"Don't let them fool us again," she said. "It is not a government takeover of health care." Aides stressed that no new federal bureaucracy would be created -- a criticism that helped scuttle the plan she spearheaded as First Lady.

Clinton's "American Health Choices Plan" (http://www.hillaryclinton.com/feature/healthcareplan/summary.aspx), which she said would cost billion a year, features an individual mandate, requiring everyone to have insurance. She likened it to state laws mandating that drivers purchase auto insurance.

Large businesses would be required to offer insurance to employees or contribute to a government-run pool that would help pay for those not covered. Small businesses won't face a mandate but also could receive tax credits to help defray their costs if they offer coverage.

Clinton vowed to enact the proposal during her first term as president and would pay the government's share by ending some of the Bush tax cuts for people making more than ,000 a year and through savings generated by reducing wasteful spending and modernizing the health system.

One part of the plan certain to run into opposition is a promise to bar insurance companies from turning down people for coverage because of health status or pre-existing conditions. "Your coverage will be guaranteed," said Clinton. "If you pay your premiums and follow the rules, your insurance company will be required to renew at a price you can afford."

Insurers believe that premiums would rise for all unless they can set different rates for patients at higher risk. Karen Ignagni, president of America's Health Insurance Plans, told USA TODAY that Clinton's plan includes "important ideas" but also "some of the divisive rhetoric reminiscent of 1993."

One of the criticisms of the 1993 effort -- Clinton joked about the scars she still has from that battle -- was that the 1,300-page plan was too complex and autocratic. This time, many of the details will be worked out in congressional committees, aides said.

Some other key elements:

• Patients could keep existing coverage or choose from dozens of the regulated private plans available to federal employees and members of Congress under the Federal Employees Health Benefits Program. The choices will typically include mental health parity and dental coverage.
• Participants would be allowed to "keep the doctors you know and trust."
• Tax credits would ensure that working families pay no more than a limited percentage of their income for health care.
• Patients could choose to enter a new government program similar to Medicare but no new government bureaucracy will be created.
• Changing or losing a job would not jeopardize coverage.

Presidential candidates of both parties were quick with their reactions.

Former North Carolina senator John Edwards, who proposed a universal health care plan earlier this year that also includes an individual mandate and a tax hike for the wealthy, said he's better equipped to fight special interests opposed to reform.

Edwards said he would push for legislation that ends health care coverage for the president, members of Congress and political appointees by mid-2009 until Congress passes his universal coverage plan.

Sen. Barack Obama, D-Ill., whose plan calls for employer but not individual mandates, said Clinton's plan is similar to his, but that his would "go further in reducing the punishing cost of health care than any other proposal that's been offered in this campaign."

Obama argued that he'd do a better job of building consensus and bringing different groups together than Clinton.

On the Republican side, former Massachusetts governor Mitt Romney said Clinton's plan relies too much on government instead of the private market. "It's bad medicine, Washington-managed health care with increased taxes and government control," he said.

The plan Romney helped establish in Massachusetts requires a similar individual mandate and uses government subsidies to help those who can't afford private insurance. Since then, he's said it should be up to the states to decide whether coverage should be required.

A statement from former New York City mayor Rudolph Guiliani said, "If you liked Michael Moore's 'Sicko,' you're going to love HillaryCare 2.0." Clinton's plan "includes more government mandates, expensive federal subsidies and more big bureaucracy."