2008 Contest Will Offer Clear Choice on Health Care

DES MOINES, Iowa _ Democratic front-runner Sen. Hillary Clinton offered a plan Monday to provide health insurance to all Americans, positioning all of the party’s major candidates as advocates for ambitious programs of either universal or near-universal health care.

Thirteen years after presiding as first lady over a failed attempt at a national health care plan, Clinton presented a plan that avoided some of the political pitfalls that contributed to the demise of the Clinton administration’s health plan in 1994. Unlike her previous effort, she would allow Americans satisfied with their current health insurance plans to continue their coverage and would avoid a large new federal bureaucracy.

The groundwork is now laid for a general-election contest that will provide a clear choice between the two parties on health care.

Republican candidates offer tax credits to lower the cost of health insurance, with private markets relatively undisturbed, while Democratic candidates urge a greater government role in guaranteeing availability of health insurance for all. The Democratic candidates would pay for their programs by eliminating Bush administration tax cuts for high-income earners and through projected savings from new efficiencies they say their plans would create in the health care system.

Clinton would offer federal subsidies to businesses and individuals to reduce the cost of health care, particularly for lower-income families, while imposing a new federal requirement that every American purchase health insurance coverage.

Her approach echoes state-based health care plans proposed by Republican Gov. Arnold Schwarzenegger of California and then-Gov. Mitt Romney of Massachusetts that require individuals to buy health insurance much as many states now require drivers to buy auto insurance.

Her Democratic rivals also borrow heavily from the Republican governors’ approach, though unlike Clinton and John Edwards, Sen. Barack Obama, D-Ill., would mandate coverage only for children, not adults. As with the California and Massachusetts state plans, the major Democratic candidates would all rely on individuals to obtain coverage by buying it or through their employers, provide subsidies for coverage and allow the public access to government-based insurance programs.

“All of the Democratic candidates have now come out with big plans,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health care policy foundation. “Those plans in the end are going to look more similar than different to Democratic voters in the primaries and, despite differences, are more similar than different.”

Clinton unveiled her plan at a publicly funded health center here, contending the nation faces a moral imperative to address the health needs of 47 million uninsured Americans.

“We can no longer tolerate the injustice of a system that shuts out nearly one in six Americans,” Clinton said. “Ultimately, this is about who we are as a people and what we stand for.”

In contrast to the complexity and forced movement of consumers into government-managed health plans that contributed to the unpopularity of her prior health proposal, Clinton and her aides portrayed her new plan as stressing simplicity, cost control and, especially, consumer choice. The campaign titled the plan the “American Health Choices Plan,” and she repeatedly used the word “choice” in her speech.

The linchpin of the plan is to require all Americans to obtain insurance so that relatively healthy people, who are less expensive to insure, balance out the cost of covering older and sicker people. Aides said she had not come up with a way to enforce the mandate, though one possibility was denying the uninsured some tax deductions.

She said most insured Americans would likely see reductions in their premiums even if they continued their current coverage. Her plan would also offer businesses, workers and the uninsured the option of buying coverage through the federal employee health benefit plan that provides insurance equivalent to members of Congress.

“Essentially the congressional health care plan becomes the American health care plan,” she said.

The new proposal would not allow insurance companies to deny coverage to people who apply and pay their premium regardless of pre-existing conditions. Insurers also would have to standardize premiums so they couldn’t charge more based on age, gender or occupation.

Large employers would be required to offer health insurance or help pay the cost of coverage. The proposal also would offer tax assistance for small businesses to provide coverage and give tax credits to lower-income individuals to purchase insurance.

The Clinton campaign estimated the cost of her program at $110 billion, which she said would be made up through savings, modernization of technology, constraining prescription drug costs and discontinuing President Bush’s tax breaks for households making more than $250,000 annually and employer tax breaks for health benefits for families earning more than $250,000.

Democratic rivals said they would be better equipped to win passage of a health care plan, noting that Clinton’s last attempt failed.

“The real key in passing universal health care is the ability to bring people together in a process that’s open and transparent,” Obama said, speaking to a union conference in Washington. “I’ve got a track record of doing that.”

In his address to a different union group meeting in Chicago, Edwards stressed that Clinton’s political miscalculations on health care plan in the White House have had significant human consequences.

“The cost of that failure … is not just somebody’s political fortune or their scars,” he said. “It’s the millions of Americans who have now gone for almost 15 years without health care.”

Romney, running for the Republican presidential nomination, denounced Clinton’s health plan as “bad medicine,” despite similarities to the plan he initiated as governor of Massachusetts.

“In her plan, it’s crafted by Washington,” Romney said. “It should be crafted by the states.”

Former New York Mayor Rudolph Giuliani’s presidential campaign criticized the plan as Clinton’s “latest health scheme” that “includes more government mandates, expensive federal subsidies and more big bureaucracy.”

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(Pearson reported from Des Moines, Dorning from Washington. John McCormick contributed from Chicago and Christi Parsons from Washington.)

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(c) 2007, Chicago Tribune.

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GRAPHIC (from MCT Graphics, 202-383-6064): 20070917 CLINTON plan

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