Hillary Clinton’s campaign updated their healthcare issues web page. There are a few interesting proposals that need Congressional action. I see some of them as plausible trade-offs in a major budget deal (you get your tax cut extension, I get a new healthcare tax credit, you get an increase in ethanol mandates, I get three years of Medicaid expansion funding for all states etc.)
There is one policy change that I think epitomizes Clinton’s governing style:
Continue to support a “public option”—and work to build on the Affordable Care Act to make it possible. As she did in her 2008 campaign health plan, and consistently since then, Hillary supports a “public option” to reduce costs and broaden the choices of insurance coverage for every American. To make immediate progress toward that goal, Hillary will work with interested governors, using current flexibility under the Affordable Care Act, to empower states to establish a public option choice.
What does that mean?
On first, non-wonkese glance, it sounds like a big plan to implement a public option and build on the ACA. The reasoning behind the goal is clear, it will introduce competition, and competition has been shown to drop premiums in competitive markets by a couple of percentage points. It helps reduce the cost of the ACA to the Federal government as the benchmark Silver plan from which all subsidies are calculated from can’t go up from the introduction of a new plan but it could go down in some markets. It increases insurance coverage as some plans will be cheaper and people who are not covered because the post-subsidy value proposition is not good enough right now, some of those people may switch into a covered states.
All of that makes sense.
Reading this in wonkese, I get something a little different than a grand plan. It is a concentrated effort to play small ball. What I see is the following sentence:
“A Clinton Administration will help states with their 1332 waivers and will lean in the direction of more coverage and state flexibility rather than the most stringent financial models. States that want to experiment can count on HHS accepting Arkansas like 1115 assumptions”
The 1332 waiver process allows states to do a lot of experimentation, customization and tweaking as long as the resultant program covers the same or greater number of people at the same or better coverage, does not leave behind the most vulnerable and does not cost the individual nor the federal government more money. Federal government cost neutrality is a key barrier. A friendly administration like the Obama Administration can allow states to make far fetched assumptions on cost neutrality to further other goals like Arkansas did for their Medicaid expansion waiver. This is what the Clinton campaign is actually promising. They’ll put the thumb on the scale for expansion and allow the supporting cost arguments to be pro-forma.
This goal is also eminently achievable.
A state level public option in a Clinton Administration requires a state to want to do the work of setting it up and a friendly Health and Human Services Secretary to certify the four major conditions are met. That is all. It does not require Congressional action so it is independent of that set of veto points. It probably does not need the courts. The process of approving a 1332 state level public option could start in the Clinton Administration on January 21, 2017.
It is aggressive small ball.