DES MOINES — Thirteen years after the collapse of her landmark attempt to overhaul national health care, Senator Hillary Rodham Clintonof New York announced her second attempt today at achieving universal coverage, unveiling a $110 billion plan that would require all Americans to have insurance and give them a range of plan options.
Under her plan, people could keep their existing coverage or pick new choices, such as an expanded version of the insurance available to federal employees or a new, Medicare-style public plan that would cost people less. Large businesses would be required to help pay for insurance for employees; small businesses and individuals would receive tax subsidies and credits to help purchase insurance.
“Today as we strive for a new beginning to the 21st century, I believe that everyone — every man, woman and child — should have quality, affordable health care in America,” Mrs. Clinton said. “We can no longer tolerate the injustice of a system that shuts out nearly one in six Americans.”
In a speech at a hospital here, as she campaigned for the Democratic presidential nomination, Mrs. Clinton said she would pay for the plan partially by ending Republican-backed tax cuts for people earning $250,000 or more, as well as by netting billions of dollars in savings by reorganizing the health care system. She also said she would press insurance companies and drug companies to focus on providing lower cost care — while at the same time, she said, she would ban insurance companies from turning down people for insurance because of health status or pre-existing health conditions.
“Now I know that these proposals will not make me the insurance industry’s woman of the year, but I don’t think I’ve been in the running for that title since 1993,” Mrs. Clinton said. “The idea is not to put the health insurance industry out of business, but to help it find a better way to make a living.”
Clinton aides planned to lay out details of the plan at a news briefing this afternoon. Questions lingered after her speech about the size of large employers that would be required to help provide care and how Mrs. Clinton would administer the new Medicare-like public plan without creating any new federal agency.
Mrs. Clinton’s plan comes months after two chief rivals for the Democratic presidential nomination, former Senator John Edwardsof North Carolina and Senator Barack Obama of Illinois, had proposed their own major proposals for universal coverage. Like Mrs. Clinton, Mr. Edwards also proposes an “individual mandate” that would require all Americans have health insurance and would raise taxes on wealthy Americans. Mr. Obama does not advocate that all adults must be covered, but rather plan would require most employers to provide insurance and provides subsidies for low-income Americans to buy insurance.
Unlike her earlier attempt, Mrs. Clinton is not proposing a new government bureaucracy. Nor would her new plan strip people of their current health insurance — a fear that helped sink her 1993 and 1994 endeavor. Indeed, even the title of her new proposal — “the American Health Choices Plan” — underscored that this approach would aim to emphasize flexibility and options, and not government-directed coverage.
“The Congressional health care plan becomes the American health care plan,” Mrs. Clinton said.
“You’ll never again have to worry about finding affordable coverage,” she said. “Your coverage will be guaranteed — if you pay your premiums and follow the rules, your insurance company will be required to renew at a price you can afford.”
Mrs. Clinton said she learned “some valuable lessons” from her experience in 1993 and 1994 in developing her plan, which was assailed by Republicans, the insurance industry and others as overly bureaucratic, complicated and the product of a secretive process.
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“I learned that people who are satisfied with their current coverage want assurances that they can keep it,” Mrs. Clinton said. “Part of our health care system is the best in the world, and we should build on it; part of the system is broken, and we should fix it.”
To pass the plan, Mrs. Clinton said she would seek to build “a solid national consensus for reform that can withstand the attacks of the special interests.” With that consensus, she predicted that she would pass her plan during her first four-year term as president.
Mrs. Clinton warned her audience not to believe Republicans who would say that her plan would create a huge new government bureaucracy — an attack that the Republican National Committee began making days ago, warning that the 2.0 version of 1990s-style “HillaryCare” was coming.
“Don’t let them fool us again,” she said of her Republican opponents. “This is not government-run — there will be no new bureaucracy, you can keep the doctors you know and trust, you keep the insurance you have, if you like that. But this plan expands personal choice and keeps costs down.”
Mr. Obama and Mr. Edwards put out statements about the Clinton plan before Mrs. Clinton even spoke, highlighting aspects of their own universal health insurance plans and gently tweaking her for laying out ideas months after they both did.
“It’s similar to the one I put forth last spring, though my universal health care plan would go further in reducing the punishing cost of health care than any other proposal that’s been offered in this campaign,” Mr. Obama said. “But the real key to passing any health care reform is the ability to bring people together in an open, transparent process that builds a broad consensus for change.”
Mr. Edwards, in remarks earlier today in Chicago, added a new proposal to his plan: He said that as president he would press legislation that ends health care coverage for the president, members of Congress and political appointees on July 20, 2009, until the Congress passes the Edwards health care plan.
Mrs. Clinton recalled that after her health care agenda was scuttled in 1994, people would ask her if she was giving up on revamping the health care system — to which she would respond with the same answer.
“I would say, ‘Why would I give up on America and the American people?’ ” she said. “For so many years I have listened to their stories, I carry their stories with me every day, and perhaps more than everyone else, I know how hard this fight will be. But that’s why I’m running for president.”
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