At the top of Amy Klobuchar’s health care web page you’ll see a photo of Amy comforting a crying veteran. It’s meant to reflect Klobuchar’s empathy as well as the failure of our current system of health care to meet the needs of Americans who have honorably served our country.
Like Pete Buttigieg, the key ingredient of Klobuchar’s health plan is to offer a public option to compete with private health plans. However, unlike Buttigieg, her approach is to allow individuals to buy into Medicare and Medicaid. Klobuchar does not describe how she will do this, although most proposals begin with lowering the age of eligibility in steps; for example allowing individuals 55 to 65 the option to buy into Medicare, the next year dropping the age of eligibility to 45, and so on.
It’s important to point out that Medicare is not a panacea. Klobuchar does not address the fact that Medicare only pays for 80% of the cost of treatment; seniors still have to purchase private health insurance to cover the remaining costs. In some cases, seniors can’t afford to purchase private, supplemental insurance. Subsidies are available to help the poorest seniors but for those who are not eligible for subsidies and who can’t afford to purchase supplemental policies, these seniors may not access health care when they should.
Although Medicare coverage is very comprehensive, it does not pay for vision, hearing, and dental care nor the cost of medications; coverage for these services are usually bundled into supplemental insurance. Supplemental insurance policies, also called Medigap insurance are costly, between $200 and $400 per person per month, depending on what is included/covered. Nor is Medicare designed to serve the health care needs of a younger population, such as pediatric, prenatal, and maternity care. Most importantly, Medicare is individual insurance – there are no family plans. Klobuchar may have Medicare-for-All in mind, where there are no deductibles and copays, but she doesn’t make that clear. Consequently, she does not explain how she will address these issues, nor does she address how this will impact costs.
Like Buttigieg, Klobuchar would expand subsidies so that individuals can purchase the public option/expanded Medicare and Medicaid, as well as help with paying for private insurance through the exchanges.
Klobuchar is the first candidate I’ve seen who would reinsure private insurers for costly, catastrophic events. Reinsurance is essentially insurance for health insurance companies to guarantee they remain financially viable if they’re hit with a lot of expensive claims. Just as we purchase health insurance, health insurance companies would purchase insurance from the U.S. government. On the one hand, this can protect an insurer from going bankrupt, which would leave all its consumers without health insurance. Conversely, this runs counter to the idea that in a free market some companies will prosper and some not.
As president, Klobuchar would increase subsidies to ensure people can afford out-of-pocket medical expenses. She would address the problem of out-of-network billing, although her plan is a bit light on how this will be accomplished.
Klobuchar would give Medicare the authority to negotiate the price of medications and she would allow individuals to purchase drugs from other countries if they are cheaper, thereby fostering competition in the U.S. The Senator has also sponsored a number of bills to lower the cost of prescription medications, such as ensuring generic drugs are available and not taken off the market if they are poor sellers.
Other key elements of her plan include (these bulleted items are taken directly from Klobuchar’s website):
- Addressing disparities in maternal and infant mortality and addressing the shortage of maternity care health professionals in underserved rural and urban areas.
- Creating a refundable tax credit to offset long-term care costs and reducing the costs of long-term care insurance.
- Taking on mental health and addiction by launching new prevention and early intervention initiatives, expanding access to treatment, and expanding Medicaid coverage for mental health and addiction treatment.
- Stopping the concerted attack to undermine and eliminate a woman’s right to make her own health care decisions.
- Investing in Alzheimer’s research with the goal of putting us on a path toward developing a cure and treatment by 2025.
- Expanding rural health care by revising Medicare rules so that rural hospitals can stay open, providing better support to critical access hospitals and community health centers, and expanding telehealth services.
- Expand the open enrollment period for health insurance under the Affordable Care Act so more people can get insurance coverage.
- Immediately suspend the Trump Administration’s efforts to eliminate the Affordable Care Act’s protections for people with pre-existing conditions.
- End anticompetitive practices that increase the price of prescription drugs, such as loopholes in regulations that allow them to refuse to provide samples or share important information about how to distribute a drug safely.
- Develop best models of care to address disparities in maternal and infant mortality and address the shortage of maternity care health professionals, including nurses, midwives, and obstetricians, in underserved rural and urban areas.
- End the sale of junk insurance policies that eliminate existing protections for consumers.
- Create incentives for employers and insurers to expand new payment models.
- Invest in the Veterans Health Administration. Klobuchar will direct the VHA to use data on private care usage only as a means to help guide investments in its own growth, not as a way to further privatize its core functions.
- Eliminate the Trump Administration guidance that provides states more flexibility to increase insurance costs for sicker people and shift premium subsidies away from low-income enrollees.
- Direct HHS to revise its current regulations for defining Health Professional Shortage areas to include VHA facilities.
- Ensure funding for Planned Parenthood, end the global and domestic gag rules, and fight for legislation that codifies Roe v. Wade and protects women’s reproductive rights
- Reassessthe granting of Medicaid waivers for states that wish to privatize the program and impose discriminatory work requirements.
- Expand investments in veterans telehealth services to ensure rural veterans have access to medical professionals, especially for mental health services.
- Strengthen the National Science Foundation and National Institutes of Health,ensure that research decisions are being made by researchers and scientists, not politicians, and bolster research at the National Institutes of Health and research into cancer, including breast cancer.
As you can see, Klobuchar’s health plan is quite ambitious, recognizing the many problems that exist in the America’s health care delivery system. The goal is universal coverage, which will be achieved through a mixed model based on expanding existing federal programs, such as Medicare and Medicaid, and continuing with private health insurance. Because it’s an incremental approach, it does address specific problems, but does not lead to a total reform of the health care system.
Klobuchar does not provide a cost estimate to achieve this plan, to pay for it
she would “increase the income tax rates for the top two brackets to the rates
that were in place before the 2017 Republican tax law, further raise the income
tax rate for the highest tax bracket and implement prescription drug reforms.” It’s notable that while Klobuchar goes after
high earning individuals, it’s unclear if raising their taxes will pay for the
$1 trillion or more a year needed to sustain these costs.