Hillary Clinton wants to change how hospitals get paid, too

Clinton will release delivery system reform proposals 'in the coming months'

On Wednesday, Democratic presidential candidate Hillary Clinton released a slew of new health care proposals, including new hospital network rules and a new tax credit to combat out-of-pocket costs.

The new proposals come one day after Clinton unveiled a plan aimed at curbing the costs of prescription drugs.

Plan details: Combating out-of-pocket costs

Clinton wants to require insurers to provide coverage for three sick visits annually that would not count towards a consumer's deductible. And she says that under her plan, consumers would "pay no more than in-network cost-sharing" if they receive care at an in-network hospital or if they are receiving emergency services "in a true emergency."

Patients are angry about 'surprise' bills. Here's how some hospitals are responding.

In addition, Clinton calls for a new refundable tax credit of up to $2,500 for individuals or up to $5,000 for families to combat out-of-pocket expenses. Specifically, the credit would be available to insured Americans that have out-of-pocket costs exceeding 5% of their income "and who are not eligible for Medicare or claiming existing deductions for medical costs." She says the tax credit would be fully funded through rebates from drugmakers and increased payments by higher-income earners.

Clinton also says she would use enforce rules under the Affordable Care Act and take further steps to increase the transparency of health plans' out-of-pocket costs, physician networks, and prescription drug costs.

New report: Out-of-pocket costs have skyrocketed

Other proposals

Clinton further proposes to combat "unreasonable" premium increases by creating a fallback option for states that do not currently have the authority to block or alter premium hikes in their state.

She also notes that health care mergers are on the rise—"both on the provider side and on the insurer side"—and says she would "vigorously enforce antitrust laws to scrutinize mergers and ensure they do not harm consumers."

Clinton also calls for leveraging public and private resources to promote entrepreneurship that improves Americans' health and financial security.

On promoting value-based care

Clinton says that reducing costs and improving quality will necessitate a continued shift away from the current fee-for-service payment system. She calls for implementing new value-based systems and expanding alternative payment models—and specifically mentions bundled payments and accountable care organizations.

Clinton also says she would promote public and private efforts to encourage insurers and employers to expand on successful delivery system reforms.

And her campaign notes she is not done issuing health care proposals—Clinton will put forward the full details of her delivery system reform plans "in the coming months," according to a fact sheet (Clinton fact sheet, released 9/23; Demko, Politico, 9/23; Gearan, "Post Politics," Washington Post, 9/23; Becker, Reuters, 9/23; Radnofsky, Wall Street Journal, 9/23).

The big picture: Understand Medicare's big move to value-based pay


HHS this year unveiled ambitious goals for reforming Medicare payments for hospitals and physicians that would make 30% of payments through alternate payment models like ACOs and bundled payments by 2016. And some key private payers have made a similar pledge. Read our Q&A with Rob Lazerow to understand what the "historic" commitment means for providers.

Then, download our easy-to-navigate field guide to Medicare payment innovation, which explains how ACOs, bundled payments, pay-for-performance penalties, and other programs fit into the Medicare payment landscape.

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