Democratic presidential candidate Hillary Clinton drew lots of attention Tuesday when she proposed capping Americans' out-of-pocket costs for prescription drugs and letting Medicare negotiate drug prices.
She drew somewhat less notice for her equally bold proposal a day later to limit consumers' out-of-pocket costs for other medical services. With that she may have hit political pay dirt—and she certainly changed the conversation away from her e-mail practices as secretary of state.
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.
“For too many, their out-of-pocket medical costs are growing much faster than their wages, meaning too much of their hard-earned take-home pay goes to paying deductibles, copays and coinsurance for medical expenses,” Clinton's campaign said in a written statement.
Her proposal may appeal to voters of all partisan persuasions. Even though millions more Americans now have health insurance thanks to the Affordable Care Act, both the newly insured and the previously insured are discovering that they can't afford to use their coverage and get care because of increasing deductibles and other out-of-pocket costs. On top of that, lots of people are getting socked with surprise bills when they unwittingly receive services from out-of-network physicians in in-network hospitals, including in emergency rooms.
The Kaiser Family Foundation reported this week that insurance deductible levels and the number of employees moving to high-deductible plans grew at a much faster pace than the premiums of employer health plans. The average deductible increased 8.3% to $1,318 for single coverage in 2015. Overall, about 24% of workers in employer plans were enrolled in a high-deductible plan with some type of savings account in 2015, compared with 20% in 2014. In 2006, only 4% of employees were in high-deductible plans. Smaller companies with fewer than 200 workers are more likely to offer high-deductible options.
Some experts question how much additional cost-sharing lower- and middle-income consumers can afford, and whether high-deductible plans are discouraging patients from seeking needed care. Many healthcare leaders are expressing growing concern over how the high cost-sharing is affecting their efforts to manage patients' chronic conditions. Having to meet a $5,000 plan deductible—or even a $2,000 deductible—is not practical for Americans who are living paycheck to paycheck.
Clinton's focus on giving people relief from rising out-of-pocket costs stands in sharp contrast to the mostly sketchy healthcare proposals from Republican presidential candidates, who generally want consumers to have more “skin in the game.” In March, Jeb Bush said he favors “catastrophic coverage.” That usually involves high deductibles, high cost-sharing and skimpy benefits. “…If you have a hardship that goes way beyond your means of paying for it, the government is there or an entity is there to help you deal with that,” Bush said. “The rest of it ought to be shifted back where individuals are empowered to make more decisions themselves.”
With her proposal, Clinton is also drawing another contrast with the GOP candidates, as well as with rival Democratic presidential candidate Sen. Bernie Sanders of Vermont. She's essentially embracing the Affordable Care Act and trying to fix one of its biggest flaws from a consumer point of view—affordability. “I want to strengthen the Affordable Care Act, because the truth is, it couldn't and it didn't solve all of our problems,” she said.
She seems to be betting that the national political debate over the expansion of health coverage to more Americans is essentially over, and now the question is who can offer the best solutions to the many remaining imperfections in the U.S. healthcare system.