5 things to know from Hillary Clinton’s NEJM article

The New England Journal of Medicine invited both major presidential candidates to write articles about their healthcare policies, but only one took the editors up on the offer.

NEJM said it asked Hillary Clinton and Donald Trump to answer the same question: “What specific changes in policy do you support to improve access to care, improve quality of care and control health care costs for our nation? Secretary Clinton responded. Mr. Trump did not respond.”

Clinton’s submission focused on her proposals to tweak the Affordable Care Act (ACA), denouncing Trump’s position that the law should be repealed, along with sections on rising health costs, integrated care and support for medical research.

1. Clinton wants a public option

The law is synonymous with President Barack Obama, but Clinton is also a major supporter, noting the gains made in reducing the uninsured rate and arguing health outcomes have been improved since it was enacted.

She argued in the article for “building on its progress” instead of repealing it. Specifically, she said Medicaid should be expanded in the 19 states which have yet to do so, “enhanced tax credits” for buying insurance should be made available and “an aggressive campaign” should be waged to boost enrollment on the ACA exchanges.

Like Obama did in his own medical journal article earlier this year, Clinton also called for new public healthcare options.

“We need to ensure the availability of a public option choice in every state, and let Americans over 55 buy in to Medicare,” she wrote. “Taken together, these policies will increase competition, choice, affordability and the number of Americans with insurance.”

2. Medicare would negotiate drug prices and insurers would be limited on out-of-pocket pharmaceutical costs

Several of Clinton’s cost-saving proposals are aimed at pharmaceutical companies, beginning with removing “barriers to competition” to make the approval process of biosimilar and generic drugs less complicated.

“That includes proposals to ensure that drug companies justify their prices, eliminate ‘pay to delay’ practices, and allow Medicare to directly negotiate for better prices,” she wrote. “I will also create a new federal consumer response team charged with identifying excessive price spikes in long-standing, life-saving treatments, and give them effective new tools to respond.”

As part of her tax credit plans, insurers would be limited on the out-of-pocket prescription costs passed on to customers, with a $250 monthly cap for covered medications.

3. Moving towards value-based care without overburdening physicians

While not offering as many specifics as other sections, Clinton’s broad statement in the third section of her article was to work “to integrate our fragmented health care delivery system with reforms that reward value and quality.”

To achieve that goal, she advocated for pushing public and private payers towards practices which both cut down costs and reward “high-quality, patient-centered care,” though she also touched on the common complaint that the focus on quality measures are distracting physicians from their clinical practice.

“We need to recognize that our health care providers are always on the leading edge of caring for Americans,” Clinton wrote. “So I will advocate for reforms that help doctors, nurses, and other caregivers spend more time with their patients, and lead our health care system into the future.”

4. Increasing medical research funding

While there has been some bipartisan agreement on providing more money for research, particularly through the National Institutes of Health, Clinton advocated for additional investments “across all diseases.” She did single out Alzheimer’s, HIV/AIDS and the cancer “moon shot” as specific research priorities.

5. She briefly touched on interoperability and health IT

While not a detailed policy proposal, Clinton did mention access to health data at the end of her article.

“I am also committed to expanding access to high-quality data on cost, care quality, and health delivery system performance to help patients and doctors make informed choices, and entrepreneurs build new products and services,” Clinton wrote. “More available information—with careful protections for privacy and security—will make our markets more efficient and transparent.”