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Clinton looks to prop up health care law if elected

Ricardo Alonso-Zaldivar
Associated Press

Washington — With the hourglass running out for his administration, President Barack Obama’s health care law is struggling in many parts of the country.

Double-digit premium increases and exits by big-name insurers have caused some to wonder whether “Obamacare” will go down as a failed experiment.

If Republican Donald Trump wins the White House, he’d start dismantling the Affordable Care Act. But If Democrat Hillary Clinton wins, she would come with a long list of proposed fixes, from rearranging benefits to introducing a government-sponsored “public option” as an alternative to private insurers. Not all her ideas would require congressional action.

“She is going to find it important to continue to expand health care,” said Joel Ario, a former Obama administration official who’s now with the consulting firm Mannatt Health.

People in the Clinton camp say she recognizes that as president she’d have to get Obama’s law working better, and is taking nothing off the table.

A look at some major ideas and their prospects:

Public option

Clinton’s primary rival, Vermont Sen. Bernie Sanders, advocated “Medicare for all” and that pushed Clinton to a fuller embrace of government-run insurance.

But Democrats could not get a public option through Congress even when they had undisputed control. Whichever party wins the Senate in November, the balance is expected to be close and Republicans are favored to retain control of the House.

While a new national insurance program seems a long shot, Obama’s law allows states to experiment. “I think the public option is more likely to be tested at a state level,” said Kathleen Sebelius, Obama’s first secretary of Health and Human Services.

Sweetening subsidies

Clinton has proposed more generous subsidies and tax credits for health care, which might also entice more people to sign up. But she’d have a tough time selling Republicans.

It may be doable in the bargaining around budget and tax bills, but Democrats would be pressed to give up some of the health law’s requirements, including a premiums formula that tends to favor older people over young adults.

Incremental changes

Whether it’s fixing a “family glitch” that can prevent dependents from getting subsidized coverage, requiring insurers to cover more routine services outside the annual deductible, or reworking the premium stabilization program for insurers, incremental changes seem to offer a president Clinton her easiest path.

Medicaid expansion

Expect a Clinton White House to tirelessly court the 19 states that have yet to expand Medicaid for low-income people. She’d ask Congress to provide the same three full years of federal financing that early-adopting states got under the health law. GOP governors would demand more flexibility with program rules.

“I’m just hoping that reality begins to sink in when she is inaugurated,” Sebelius said. “If the law is not going to go away, then let’s make it work.”