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Hillary Clinton answers questions from AHCJ members

Election 2008

See AHCJ's Election 2008 resource, with news and links to the candidates' statements about health care issues.

1) Should there be universal insurance coverage in this country?

Yes. When I am President, providing quality, affordable health care to every single American will be my top domestic priority. Part of why I am running for President is to provide universal coverage.

2) If you believe in universal insurance coverage, how would you achieve it (i.e., employer mandate, individual mandate, single payer)?

My American Health Choices Plan will provide quality, affordable health care to all Americans, including the 47 million who don't have coverage today. I believe we have a moral imperative to ensure that every American has quality health care.

My plan is based on the principles of shared responsibility and choice. If you have a plan you like, you can keep it. If you want to change plans or don't have coverage, you can choose from the same plans available to Members of Congress or opt into a public plan option like Medicare. My plan maintains the employer-based system and builds on it. I have proposed an individual requirement to ensure everyone has health coverage. Under my plan, families will get a refundable tax credit so that their premiums never exceed a certain percentage of family income and small businesses will receive a tax credit for providing health care to their employees. My plan will ensure that insurance companies cannot discriminate against people on the basis of age, race, gender, or other risk factors, like pre-existing conditions.

3) Should private insurance companies be allowed to choose who they want to insure, taking into account a person's age and health status?

No. Under my plan, insurance companies will be prohibited from discriminating against people on the basis of age, race, gender, or risk factors like pre-existing conditions or health status.

Hillary Clinton4) If you or someone else in your family has ever been uninsured, what was that experience like?

Throughout my campaign, I have traveled across the country, listening to Americans talk about the challenges and struggles they face today. Health care - or lack thereof - is one that comes up consistently.

Earlier this year in Dubuque, Iowa, I met Judy Rose and her husband, John. Back in 2001, John lost his job of 30 years when the plant where he worked closed with just one day's notice. And, as a result, Judy and John lost their health insurance. A couple of months later, Judy was diagnosed with breast cancer. Thankfully, a special government program took care of her treatment and she recovered. But then, in 2003, John had a heart attack. He spent hours in surgery and was in the ICU. Fortunately, he survived. But when the bills came, their luck ran out. The cost of John's care was so high that they had to sell the home they had lived in for 30 years.

Stories like this one are the tragedies at the heart of our health care system. When I am President, I will ensure that all Americans have access to quality, affordable, health care. And coverage will also be reliable - Americans will not lose their coverage if they switch or lose their jobs.

5) Explain why your approach for reducing the nation's health care costs would succeed?

A key component of my goal to provide universal health care is to cut costs throughout our entire health care system, which will make health care more affordable for all Americans. I laid out my health care agenda in three steps - addressing cost, quality, and coverage. I started with cost because all Americans are struggling with high health care costs. I proposed that we focus on comprehensive preventive care, which will keep our costs down in the long run and improve Americans' quality of life. In addition, I believe that we must coordinate and streamline care for people with chronic illnesses, which accounts for 75 percent of health care costs. Under my health care plan, individuals and small businesses will have market access to larger insurance pools that will lower costs, and insurance companies will be prohibited from discriminating against people with pre-existing conditions. I also proposed that we modernize our health care system, by, for example, using electronic medical records and other health information technology to make our health care system more efficient and less costly.

6) How would you put Medicare on a solid financial footing for the rest of the century?

The biggest challenge to our fiscal future lies in Medicare - and, in particular, in controlling our rising health care costs. The Congressional Budget Office reported recently that we've largely "misdiagnosed" our fiscal problems by focusing on the demographics of the baby boom retirement rather than on health care costs. If health costs continue to grow at their current rate, federal spending in Medicare and Medicaid will more than quadruple by 2050. But if we hold health costs down, the impact of our aging population alone on these programs will be much more manageable. That's why I have proposed a plan to provide quality, affordable health care to all Americans that will also reduce costs throughout our health care system. Insuring everyone - providing them with preventive services, care management, and quality acute care throughout their lives - is not just the right thing to do, but is essential for lowering costs and reducing the long-term burden on Medicare.

With Medicare, we need to start getting drug costs under control by allowing Medicare to negotiate for lower drug prices and to lower those costs for everyone. We should also create a pathway for biogeneric drug competition and remove barriers to generic competition. And we have to crack down on the overpayments in Medicare to private plans - doing so could result in $10 billion in net savings annually. I will also build on my past efforts to ensure that all Medicare beneficiaries receive the assistance they need. Specifically, I will work to help those who fall into the "doughnut hole" and can't afford the prescription drugs they need. And I will work to make Medicare and Medicaid reimbursements fair so that all communities in our country - including ones in rural areas that traditionally have lower reimbursement rates and, as a result, have difficulty recruiting doctors - have qualified doctors. When I am President, I will work to create a system that is fair and ensures that all Americans receive quality care.

7) Should the government allow those 55 and older to buy into the Medicare system at their own cost?

Under my plan, Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.

8) Will pay-for-performance plans, in which providers are paid based on their quality scores, further stratify the disparity between rich and poor patients?

That won't happen under my health care plan because it provides funding for the development of consensus-based quality measures and it will reward health care providers who incorporate those standards into their medical practices. These quality measures must be developed in a way designed to reduce health disparities. In today's health care system, low-income Americans without coverage often have limited access to high-quality health care services. That will continue to be a problem in a reformed system in which some Americans remain uninsured.

Under my plan, every American would have access to quality, affordable health care, regardless of income. High-quality health care providers would have no incentive to turn away low-income patients. Today, traditional safety-net providers that serve a disproportionate share of uninsured low-income patients - such as public hospitals and community health center - have significant uncompensated care burdens. Under my plan, safety-net providers will see an increase in funding as more of their patients are insured, assuring adequate resources to continue to provide high-quality health care and to incorporate quality measures into their medical practices and qualify for higher reimbursement based on the quality of care provided.

9) What should the U.S. national policy be for paying for long-term care?

Today, 90 percent of all long-term care received is informal, primarily provided by spouses and adult children - overall, as many as 52 million Americans are informal, unpaid caregivers. To ease the financial burden on these families, I have proposed, as a part of my long-term care agenda, a new refundable $3,000 Caregiving Tax Credit. I will also invest more than $300 million a year in state efforts to support unpaid family members - I will fully fund the Lifespan Respite Caregiver Act at about $60 million per year and double funding for the National Family Caregiver Support Program to $250 million per year. I will allow more seniors to access long-term care services where and when they need it, including in their homes. And I will double the elderly standard deduction to provide additional financial relief for 11 million elderly taxpayers.

I believe that we need to do more to ensure that long-term care insurance provides real security and support. Therefore, I will take aggressive steps to increase consumer protections for long-term care insurance policies, alongside efforts to increase the affordability and access to quality long-term care insurance. I will reach these goals by requiring strong new consumer protection for long-term care insurance, allowing consumers to purchase the same secure long-term care insurance policies available to Members of Congress, and providing a new long-term care insurance tax credit to make secure insurance plans affordable.

And I will commit to improving the quality of our country's nursing homes. It is unacceptable that, in 2006, nearly one in every five nursing homes that received federal funds was cited for serious deficiencies in care. When I am President, I will triple federal support for nursing home ombudsmen programs, which are crucial to combating fraud and abuse in the long-term care industry; direct the Department of Justice and the Federal Trade Commission to assist state consumer advocates and prosecutors to tackle persistent abuses and new challenges in the industry; reverse the inexcusable policy of the Centers of Medicare and Medicaid Services of withholding information about poor-performing nursing homes and provide seniors full access to data on nursing homes; and strengthen our nursing and direct-care workforce with a national system of background checks for long-term care workers and a $125 million investment in Workforce Investment Programs.

10) What steps should the federal government take to reduce obesity and diabetes, which are looming as the greatest threats to public health?

Chronic illness accounts for 75 percent of health costs and two-thirds of recent cost growth. Obesity rates have doubled among adults over the past 20 years; in fact Medicare could save more than a trillion dollars over 25 years if obesity among seniors could be returned to levels in the 1980s. One out of three children born in 2000 is at risk of developing diabetes, and - for the first time in our nation's history - today's children are at risk of having shorter life spans than their parents. A key component to my health care plan is prevention - obesity and diabetes are two areas where education and prevention can go a long way.

I will require all insurers participating in federal programs to cover prevention priorities. I will make it a condition of doing business with the federal government that health plans cover high-priority preventive services. Covered services would be based on recommendations from the U.S. Prevention Services Task Force. Insurers would provide both individuals and providers with financial incentives, such as eliminating co-pays for high-priority prevention services. This approach is being taken by such businesses as Safeway, which not only covers all preventive services but provides an integrated health promotion model for many of its employees.

I will also target prevention by coordinating and pooling public funding. I will coordinate public spending on prevention across federal programs in the Department of Health and Human Services to maximize high-priority prevention. A public-private collaboration would ensure that prevention is pushed outside of the boundaries of the health care system and into schools, the workplace, supermarkets and communities through free provision of preventive benefits. It would enlist a new prevention workforce including pharmacists, church leaders, and others who can best use funds to ensure 100 percent use of cost-effective prevention.

11) What further steps need to be taken to protect U.S. citizens in the face of a global pandemic?

Building on the efforts I have championed as Senator, I will, when I am President, work with the Centers for Disease Control and Prevention and the Department of Health and Human Services to ensure that we work to prevent and to be prepared for any kind of global pandemic.

As a co-sponsor of the Pandemic and All-Hazards Preparedness Act, I fought to designate the Secretary of Health and Human Services to lead federal efforts in public health emergencies. The Act requires the Secretary to develop a coordinated strategy, to be known as the National Health Security Strategy, to address pandemics and public health concerns. It also requires the Secretary to develop a strategic plan with respect to pandemic and biodefense vaccine and drug development. As President, I will ensure that the Act is implemented and that we are more prepared for a pandemic.

I introduced the Influenza Vaccine Security Act to address our overall national response to seasonal influenza. This bill would improve the ability of the Centers for Disease Control and Prevention to provide outreach to high-risk populations, such as young children, and improve vaccination rates among those most at risk of complications from influenza. This legislation also establishes a tracking system through which we can better trace the distribution of vaccines from the factory to the provider and identify counties with high numbers of priority populations.

Recently, I co-sponsored the Community and Healthcare Associated Infections Reduction Act, which would improve the prevention, detection, and treatment of antibiotic-resistant community and healthcare-associated infections. The bill would require the federal government to develop best practices guidelines for hospitals' infection control plans. It would also require hospitals to report their infection rates to the Centers for Disease Control, which would make the data available to researchers, and would introduce a Quality Improvement Payment Program through Centers for Medicare and Medicaid Services to provide payment subsidies to hospitals for lowering hospital-acquired infection rates.

12) What will you do to ensure that federal agencies are performing research based on scientific models and reporting information objectively on controversial health issues of the day?

When I am President, I will end the Bush administration's war on science. We will once again stand up for science and research, for open and free inquiry, and for the critical investments that will make us richer, safer, smarter and stronger in the years to come. I will restore the federal government's commitment to science and science integrity by signing an Executive Order that rescinds President Bush's ban on ethical embryonic stem cell research and promotes stem cell research that complies with the highest ethical standards; bans political appointees from altering or removing scientific conclusions in government publications without any legitimate basis for doing so, and prohibits unwarranted suppression of public statements by government scientists; directs all department and agency heads to submit annual reports on the steps they have taken to safeguard against instances of political pressure threatening scientific integrity and to promote openness and transparency in decision-making; reverses President Bush's new directive that dramatically expands political appointees' control over agency rulemaking; and revives and expands the national assessment on climate change, going above and beyond the requirements imposed by Congress. I will also work to restore the science advisor's direct access to the President, to re-establish the Office of Technology Assessment, protecting the integrity and independence of federal scientific advisory committees, and strengthen whistleblower protections for those who disclose potential instances of political interference with science. As part of my commitment to the science of medicine, I have also proposed to increase the National Institutes of Health budget by 50 percent over five years and to double it over 10 years.

13) How would you change the financial incentives in health care to reward improvements in the actual health of patients, rather than linking reimbursements to the number of procedures performed?

I have proposed to incentivize quality through increased federal payments. Most federal payments to health care providers do not differentially reward high-quality providers. Our current system of reimbursement creates barriers to collaboration among organizations and among health care professionals, leading to fragmentation in the health care system.

I will financially reward excellence in care. I will offer higher reimbursement rates to doctors who participate in qualified Maintenance of Certification (MOC) programs and whose patients, over time, have improved health outcomes. These physicians will be recognized as providers of high quality care and will receive higher reimbursement in federal programs, such as Medicare and the Federal Employee Health Benefit Program. Studies have shown that patients of doctors who participate in certification programs have better outcomes. I believe that our federal reimbursement system should reward care based on how effective it is.

I will also develop new reimbursement models to encourage innovative care delivery systems that reward quality, not assembly-line care. To address system-wide fragmentation, increased reimbursement will be provided to doctors who use models of care that treat patients as whole individuals instead of treating each of their illnesses separately. Such approaches will eliminate piecemeal medicine, where multiple doctors and nurses treat conditions like diabetes or cancer without communicating and undermining care as a consequence. Care models that use teams of providers - physicians, nurses, pharmacists, nutritionists, social workers, and other allied health professionals - that meet consensus-based quality measures will be recognized.

14) How can the government narrow health care disparities among ethnic and economic groups and people living in different regions?

While many factors contribute to the disparities in health outcomes, no factor matters more than access to health insurance. That's why my plan, which offers universal health care, will be vital to closing the racial, ethnic and geographic health disparities that are pervasive throughout our health care system.

My plan requires the development and testing of quality measures for use by doctors, hospitals, nursing homes and other providers targeted at eliminating racial and ethnic disparities in health care. It directs the Department of Health and Human Services to develop a uniform reporting format for the collection of quality information on race and ethnicity, so that we can know the full extent of the problem and measure our progress in addressing it. It provides $50 million in federal funding for the development of culturally and linguistically competent clinical care programs, to ensure that our healthcare providers can communicate with their patients and have training and skills to fully understand and respect cultural differences in the patients they serve. And my plan addresses diversity and cultural competency in the healthcare workforce by providing opportunities and incentives to encourage greater diversity in our health care workforce through recruitment initiatives, scholarships and loan-forgiveness programs.

15) Who should bear the cost of hospital-acquired infections and medical errors?

My health care plan will prohibit payment of "never events" in Federal Employee Healthcare Benefits Program and all federal programs. The Bush Administration's recent decision to refuse Medicare payments for preventable infections, injuries and errors - so-called "never events" - sustained during hospital stays is a positive step. I will insist that any insurance company wishing to provide coverage through the Federal Employee Healthcare Benefits Program also refuses to cover these costs. This proposal will incentivize good care with smart reimbursement policies.