Obama Camp Memo on Clinton's Health Care Plan

To: Interested parties
From: Obama campaign

Re: How much will Hillary Clinton's plan to go after your wages cost you?

We know that one of the biggest challenges the next president will face is fixing our broken health care system. 47 million Americans are uninsured, and millions more are struggling to pay premiums and co-payments that are rising faster and faster every year. Barack Obama believes that the reason that people don't have health care is not because they don't want it, but because they can't afford it. That's why he has laid out a detailed, universal health care plan that will do more to cut costs than any other plan – up to $2,500 for the average family.

Senator Clinton's plan includes an individual mandate that would force everyone to buy health care. If you do not do this, usually because you can't afford health care, Senator Clinton has suggested she will go after your wages, but she hasn't explained what that means.

Senator Clinton says in her stump speech, “I am in the solutions business…I think we need answers, not questions.” But her particular solution raises a lot more questions than answers.

Families struggling with skyrocketing health care costs deserve to hear from Senator Clinton what she means when she says one option for enforcement is “going after people's wages.” What does that mean for families in Texas already struggling with medical bills? A family Blue Cross Blue Shield plan under the Federal Employee Health Benefits Program, which Senator Clinton wants to expand to cover more Americans, costs $12,000 a year. How much will families have to pay out of their pocket to buy health insurance under her plan?

The Clintons' efforts to reform health care in the 1990s didn't fail for a lack of good ideas, but because the process was too secretive and they were unable to bring people together behind their plan. Those who disagreed with Senator Clinton were ‘demonized', and when Congress and the American public were shut out of the process, the drug and insurance companies moved in to fill the void.

To finally pass universal health care, the next president will have to engage in an open, honest process that considers all ideas, brings people together, and includes the American people in a conversation about the challenges we'll face.

But Senator Clinton still owes the American people a straight answer to a simple question – what does she mean when she says she will go after your wages?

Senator Clinton's Record on Health Care

FEBRUARY 3, 2008: Clinton Says People Who Don't Sign Up For Health Insurance “Won't Have to Pay Fines”; Then Says One Option For Enforcement is “Going After People's Wages.” When asked about her enforcement mechanism, Clinton said, “Well, they don't have to pay fines, George. We want them to have insurance. We want it to be affordable.” When pushed again on whether or not she would garnish wages, Clinton said, “George, we will have an enforcement mechanism, whether it's that or it's or it's some other mechanism through the tax system or automatic enrollments…And the reason why I think there are a number of mechanisms, going after people's wages, automatic enrollment, when you are at the place of employment, you will be automatically enrolled, whatever the mechanism is...” [ABC, 2/3/08]

DECEMBER 1, 2007: Clinton Said She Would “Look At” Withholding Part Of Their Salaries To Pay For It. On a conference call with reporters to discuss the ad, Clinton policy chief Neera Tanden said the senator would “look at” working with employers to “automatically enroll employees, going through and withholding part of their salaries to pay for it - those are reasonable steps to enforce a mandate.” When Clinton rolled out her plan earlier this year, Tanden hinted that the mandate might be enforced by threatening to deny tax deductions to people who refused to enroll for insurance. [DMR, 12/1/07 <http://www.newsday.com/news/nationworld/ny-ushill015484077dec01,0,1345390,print.story> ]

EXPERTS SAY MANDATES NEED “HARSH SANCTIONS” IN ORDER TO BE EFFECTIVE

Letter From Health Care Experts: Mandates Without Harsh Sanctions Won't Result In Coverage. “Regardless of our feelings on this issue, what is clear from the evidence is that mandates alone, without strong incentives to comply and harsh punishments for violation, will have little impact on the number of uninsured Americans.1 Indeed, as the Massachusetts experience illustrates, non-compliance with mandates is a large problem, absent harsh sanctions. There is simply no factual basis for the assertion that an individual mandate, by itself, would result in coverage for 15 million more Americans than would robust efforts to make health care more affordable and accessible.” [Letter from Health Care Experts, 1/31/08]

CLINTON STILL HASN'T ANSWERED WHAT KIND OF PENALTIES SHE WOULD HAVE UNDER HER PLAN – BUT OPTIONS INCLUDE:

Under the Health Security Act, Failure to Register With a Health Alliance And Pay Premiums Resulted in Fines of At Least $5,000 or As Much As Three Times Amount Owed. Under President Clinton's Health Security Act, “All American citizens not specifically exempted will be required to register with a health alliance. Individuals, families or employers must pay their required premiums. Failure to pay can result in a fine of $ 5,000 or three times the amount owed, whichever is greater. Health alliances will have government help in collecting from deadbeat subscribers: ‘Each state shall assure that the amounts owed to regional alliances in the state are collected and paid to such alliances.'” [Times Union, 1/2/94]

Senator George Mitchell's 1994 Health Care Plan Contained A Fine Of Up To $10K Per Worker On Employers Who Fail To Offer A Health Care Plan; Senate Voted 100 To 0 To Drop The Provision. “Majority Leader George J. Mitchell (D-Maine) and Minority Leader Robert J. Dole (R-Kan.) were conciliatory but noncommittal after back-to-back appearances before the group. Members said both leaders encouraged their efforts and plan to meet with them again today after their final proposal is ready. The surprise meeting came as the Senate slogged through its second day of voting on Mitchell's scaled-back version of health reform legislation originally proposed by President Clinton. With Democrats ceding a victory to Republicans, the Senate voted, 100 to 0, to drop proposed fines of up to $ 10,000 a worker on employers who fail to offer a health plan providing a standard set of medical benefits. … They argued that the $ 10,000 penalties exemplified the ‘heavy hand of government' present throughout the 1,443-page Mitchell bill. The Mitchell plan attempts to use subsidies and insurance reform measures to increase insurance coverage to 95 percent of the population by the year 2000. If coverage falls short, employers might be required to pay 80 percent of the cost of their workers' insurance.” [Washington Post, 8/18/94]

Range Of Options For Enforcing Individual Mandate Are Unpopular. “Enforcement of an individual mandate could vary from requiring documentation of coverage on tax forms, as the Chafee plan proposes; facing a fine equaling 120% of a typical premium; or revoking personal income tax exemptions for those who don't buy insurance, as the Nickles-Stearns bill suggests. "But many observers think that tough IRS enforcement would be politically unacceptable and logistically difficult." Nelson: "You could nail people by doubling their income tax, but what difference does it make if they have no assets?" Furthermore, "most uninsured people wouldn't be found out until after they became ill," which ACP's Dr. Paul Griner calls "a nightmare." [American Health Line, 1/21/94]