Seven ways Hillary Clinton would change healthcare

Democratic presidential candidate Hillary Clinton vows to provide more affordable, cost effective, accessible, and higher quality healthcare and insurance coverage.

She plans to achieve this by modifying the Affordable Care Act (ACA). “These modifications could lead to further decreases in the number of uninsured people as Medicaid expansion continues and as problems within the public exchanges are fixed,” says James Smith, MBA, FACHE, executive vice president, GE Healthcare Camden Group, Rochester, New York.

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Here’s a closer look at seven key ways Clinton would change the healthcare system if elected president:

#1. Increase enforcement of existing ACA requirements

In an effort to make healthcare more affordable and cost effective, Clinton proposes to increase the enforcement of existing ACA requirements, such as requiring health insurers to disclose the costs of specific medical services, claims payment policies and practices, and certain quality data to consumers, says Joseph M. Mack, MPA, president, Joseph Mack & Associates, Dana Point, California. Clinton has also vowed to block or modify unreasonable health insurance rate increases.

#2. Enhance tax credits for families.

What’s more, according to Clinton’s official website, she wants to provide a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above 5% of their income.

She wants to enhance the premium tax credits now available through the exchanges so that those now eligible will pay less of a percentage of their income than under current law and ensure that all families purchasing on the exchange will not spend more than 8.5% of their income for premiums.

Finally, she will fix the “family glitch” so that families can access coverage when their employer’s family plan premium is too expensive.

#3. Waive out-of-network fees in cases of true emergencies

Clinton also recommends that patients obtaining care in an in-network hospital pay no more than in-network fees to the hospital and physicians-even if they are out of network-for any services in a true emergency.

#4. Provide new incentives to expand Medicaid

In an effort to make healthcare more accessible, Clinton plans to expand Obamacare and supports new incentives to encourage all states to expand Medicaid. “She praised Arkansas for carrying out a new approach to expanding Medicaid coverage by using federal money to buy private health insurance for more than 100,000 low-income residents,” Mack reports.

#5. Create a public option choice

Among other changes to the ACA, Clinton wants to create a public option choice, making enrolling in exchanges easier and providing greater access regardless of immigration status. “Most likely Clinton won't try to push the public option through Congress, but instead will work with governors using existing flexibility under Obamacare to empower states to establish a public option choice,” Mack says.

#6. Expand value-based delivery reform

As far as providing higher quality healthcare and insurance coverage, Clinton has proposed expanding value-based delivery system reform in Medicare and Medicaid. “Health plans should continue working with large regional providers, as well as The Core Quality Measures Collaborative (CQMC), comprised of America’s Health Insurance Plans (AHIP) and its member plans, and certain national physician organizations to standardize the evaluation and improvement of clinical and financial outcomes,” Mack says. “Data enables health plans to remove underperforming hospitals and physicians from their networks. However, payers should work with providers to use data to produce useful information that positively changes practice patterns, cost, and patient satisfaction.”

#7. Encourage technological innovation

In addition to promoting value- and quality-based reimbursement systems, Clinton has touted changes to the care delivery system-rewarding the creation of telehealth solutions and technological innovations. “These strategies could increase private insurers’ membership,” Smith says. “Health insurers would be incented to provide solutions which increase quality, accessibility, patient experience, and cost control.”

Key takeaways

“These investments could lead to further governmental influence, calls for greater oversight and compliance, and for even greater privatization of services such as continuing the growth of the Medicare Advantage program or eventual centralization of services toward a single-payer system,” Smith says. “Each would lead to demands for greater accountability and better accessibility to health and healthcare services and lower costs.”

Furthermore, under a Clinton administration Mack expects to see some type of bundled payment system. “We will see continued experimentation of commercial accountable care organizations or private exchanges in which self-insured employers, including hospitals, create their own HMOs and/or partner with national insurers to control the defined contribution costs of insurance,” he says. “These organizations compete in the market on premium pricing and quality. Some of these initiatives have already been successful by shifting price risk to employees. The challenge for insurers, and particularly for providers, is true cost reduction rather than merely shifting risk from employers and/or providers to insurers with larger risk pools, and increasing value to consumers.”

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.