By Beth Fouhy
Monday, September 17, 2007
DES MOINES -- Sen. Hillary Rodham Clinton's sweeping health-care proposal, which she plans to unveil today, would require every American to carry health insurance and offer federal subsidies to help reduce the cost of coverage.
The proposal, Clinton's first major effort to achieve universal health coverage since an ill-fated 1994 plan, carries a price tag of about $110 billion per year. The centerpiece of her "American Health Choices Plan" is an "individual mandate" requiring everyone to have health insurance -- just as most states require drivers to purchase auto insurance.
"It puts the consumer in the driver's seat by offering more choices and lowering costs," said Neera Tanden, Clinton's top policy adviser. "If you like the plan you have, you keep it. If you're one of tens of millions of Americans without coverage or don't like the coverage you have, you will have a choice of plans to pick from and you'll get tax credits to help pay for it."
The New York Democrat is expected to introduce her plan in Iowa, whose caucuses are the nation's first primary vote. Details of the plan were provided to the Associated Press in advance of her speech.
With 47 million Americans currently uninsured, the Democratic presidential contenders have been united in advocating universal coverage. They have parted ways on certain specifics, including the individual mandate -- the plan offered by former senator John Edwards (N.C.) includes one, while the proposal outlined by Sen. Barack Obama (Ill.) does not.
Republican skeptics say such a mandate would be too invasive and would restrict personal freedom and choice. Liberal Democrats have expressed concern that it would be too financially burdensome for lower-income individuals and families -- a concern shared by Obama, who has said that individuals cannot be forced to purchase insurance until the cost of coverage is substantially reduced.
Clinton's aides said she believes that an individual mandate is the only way to achieve health care for all. A key component of her plan would be a federal tax subsidy to help individuals pay for coverage.
Clinton's plan builds on the existing employer-based system of coverage. People who receive insurance through the workplace could continue to do so; businesses, in turn, would be required to offer insurance to employees, or contribute to a government-run pool that would help pay for those not covered. Clinton would offer a tax subsidy to small businesses to help them afford the cost of providing coverage to their workers.
For individuals and families who are not covered by employers or whose employer-based coverage is inadequate, Clinton would offer expanded versions of two existing government programs: Medicare and the health insurance plan offered to federal employees. Consumers could choose between either program. Aides emphasize that no new federal bureaucracy would be created under the plan.
Aides said Clinton will propose several measures to pay for her plan, including an end to some of the Bush-era tax cuts for people making more than $250,000 per year. Edwards has vowed to completely repeal the tax cuts for high earners to pay for the cost of his plan, estimated at $90 billion to $120 billion per year, while Obama would pay for his plan in part by letting the tax cuts expire in 2010.
Clinton is also expected to emphasize cost-cutting measures to help pay for universal coverage. She has already recommended several such proposals.