Politics & Government

How Clinton's health plan compares to her rivals'

WASHINGTON — On Monday, Sen. Hillary Clinton, D-N.Y., became the third leading Democratic presidential candidate to offer a detailed fix for the nation's health care industry. Here's a look at similarities and differences among the three plans.

Q: Does the Clinton plan go beyond those offered by former North Carolina Sen. John Edwards and Sen. Barack Obama, D-Ill.?

A: All three propose universal health coverage, bringing everyone without insurance into the system through tax credits for employers and/or individuals and subsidies for the lowest-income workers. Edwards and Clinton would require all Americans to have health insurance. Obama's plan guarantees coverage for all Americans but does not require all to have it.

The three plans would prohibit insurers from denying coverage because of pre-existing conditions or genetic risks for disease. The plans also would provide for portability of insurance to ensure coverage in the case of job loss or career change.

"They're a lot closer together than farther apart," said Robert Blendon, a health policy expert at Harvard University.

Q: How much would universal health care cost? How would it be paid for?

A: The estimated costs of transitioning to universal health care range from $100 billion to $200 billion in the first year, with lower annual costs after that, economists say. Edwards says his plan would cost $90 billion to $120 billion. Obama says his will cost between $50 billion and $65 billion. Clinton put the cost of her plan at $110 billion.

To pay for their plans, all three propose administrative savings but are also eyeballing the wealthiest taxpayers. Clinton would target Americans with annual incomes above $250,000, rolling back some of the Bush-era tax cuts set to expire in 2010. Obama would let the tax cuts expire across the board in 2010. Edwards would roll back tax breaks for the wealthiest Americans, and his cutoff point is $200,000 in annual income.

Q: Would they change employer-sponsored health care plans?

A: Not for most Americans, maybe for some. All three plans would allow consumers already in an employer-provided health plan to stay put and to stick with their preferred doctors. Obama and Clinton both propose tax credits for small businesses to help them provide insurance to their workers. All three would offer tax credits to lower-income workers who purchase health coverage.

But Clinton offers a potentially radical policy change. Since World War II, employers have deducted from taxes the costs of providing health insurance to their employees, giving workers a tax-free gift. Clinton proposes that for Americans with income above $250,000 who receive generous employer-provided plans, a portion of those plans be treated as taxable income.

"That's a major change. That's one the Republicans have been pushing for a long time," said Kenneth Thorpe, a health policy professor at Emory University in Atlanta.

Q: Are these plans government or socialized health care?

A: No. All three plans would leave the existing private system in place. Edwards would create Health Care Markets — state and regional non-profit insurance-purchasing pools — to offer consumers a choice of competing insurance plans. At least one of those plans would be a public program based on Medicare. If more people choose that public plan, it could lead to a single-payer approach like in Canada, where government administers health care, collecting fees and paying out costs.

Obama proposes a National Health Insurance Exchange to help individuals and employers buy health insurance. But he doesn't talk of a single-payer system. Clinton said Monday she wouldn't build any new bureaucracy.

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