Seismic Change and Micro-Innovation

Excerpt

As the September 2016 issue of JGIM rolls off the presses, the country will be preparing for what may be one of the most consequential presidential elections in history. What is at stake for health care in this election? On the Democratic side, Hillary Clinton’s campaign has released detailed plans reflective of her deep involvement with Bill Clinton’s health care reform efforts in the early 1990s. (If Bernie Sanders is the nominee, the conversation will be different.) The essence of the (Hillary) Clinton health plan is to preserve, refine, and enhance the Affordable Care Act of 2010. Her proposed alterations include a series of wonky measures that promise to increase access, control costs, or improve quality—all at the margin. For example, one provision would permit up to three “sick” visits per year free of out-of-pocket costs (deductibles and co-pays). Another would eliminate the ability of pharmaceutical companies to deduct the costs of direct-to-consumer advertising from taxable income and require FDA pre-clearance of such ads. A third would offer a tax credit to families whose out-of-pocket health care expenses exceed 5 % of their annual income. The Clinton plan also includes some vague references to insurance market reform, but it is unclear whether these modest initiatives will solve the problems highlighted by United Healthcare’s recent exit from most of the 34 ObamaCare health exchanges where the large health insurer previously offered coverage. …