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Clinton health plan 2.0, updated

Now that Hillary Clinton is the Democratic Presidential nominee, it’s time to delve into her health policy platform.  The quick recap is she is looking to expand and build on ACA, tweaking various parts and pieces to fix legislative errors, incent states to participate, and reduce out of pocket costs. (we discussed this in yesterday’s Blab; you can watch it here.)

Expand Medicaid

Clinton would offer 100% funding for any state that expands Medicaid for at least three years, then tapering down to 90%.  This would likely encourage more states to take the step; Florida and Nebraska are two where elected officials are under increasing pressure to make the move.

Remove the family glitch

A drafting error doesn’t allow taking an employee’s family into account when determining subsidies for insurance bought via the Exchanges.  Clinton would offer tax credits to offset those out of pocket costs for eligible families.  The tax credit proposal is a convoluted way to fix what should be done via correcting the original language.

Allow near-seniors to buy-in to Medicare

More an idea than an actual policy position, Clinton is talking about allowing “people 55 or 50 and up” to voluntarily pay the entire “premium” to join Medicare.  With much to be fleshed out, this looks to be a response to Sen Sanders’ call for free public insurance for all.

This could have some major downstream effects; by removing we older and more expensive people from the privately-insured pool, insurance costs for younger folks would decrease.  This “public” option would also inject competition into areas where there isn’t any due; rural markets in particular could benefit.

Address drug prices

Clinton has several ideas including eliminating the tax deductibility of marketing expenses, setting limits on consumers’ out of pocket costs for prescription drugs, and allowing Medicare to negotiate directly with drug companies.

Most striking is the mostly-unformed concept of forcing drug developers to spend a set amount on R&D, with any additional revenues handed back to the Feds for government research on new therapies. This is intended to address the industry’s argument that research costs demand high prices (an oft-criticized and rather doubtful argument).

Sounds good, but I doubt – very much – if it could be implemented without causing a lot of problems as drug companies quickly figure out ways to game the system.

At some point it may make sense to review Trump’s, but at this point the GOP nominee  has yet to come forth with any coherent health reform plan other than “repeal Obamacare” and sell insurance across state lines.

3 thoughts on “Clinton health plan 2.0, updated”

  1. Joe, listened to yesterday’s Blab – great cliff notes update on health policy issues.

    Your last comment that mental health costs are rising faster than cardiac care needs further analysis. I think the rising mental health costs are much broader then our aging population. Mental health is the leading cause of disability and health plan costs for many employers. Have you seen any analysis on total medical expenditures by category and percentage of population age bands? If we look broadly at total mental health costs, seniors will have the highest costs every time, they are a larger percentage of our population.

  2. Either way health care in this country is facing huge changes and challenges without even taking into account the amount of control the Federal Government has now taken for itself with ACA. As we all know centralized control benefits few and restricts and controls the majority. As a consumer I am more restricted in my choices when it comes to my care, providers and treatment options while having to foist higher costs, out of pocket liabilities that reset every year and that are impossible to budget for or re-insure. The only ‘real’ solution if to get all government out the ‘health insurance’ business and if they are serious about providing healthcare then let them build the hospitals, clinics and facilities and hire the para and professional staff to take care of their targeted populations. Since working within in a budget and staying out of debt is a figment for government they might as well embrace a British NHS model or Spains’ INSALUD model and be done with it.

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Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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