Top advisor says Hillary Clinton flexible on health care, but not block grants 

Hillary Clinton wants to work with states and provide flexibility in health care but is not supportive of a block grant approach, one of Clinton’s three senior policy advisors said Wednesday (Feb. 26).

In an interview in Little Rock, Ann O’Leary, 44, said Clinton is watching the debate over Arkansas’ private option, the program created in 2013 that uses federal Medicaid dollars to purchase private insurance for adults with incomes up to 138% of the federal poverty level. O’Leary called it a “bipartisan success story.”

Crafted by Republican legislators and Gov. Mike Beebe’s (D) administration, the program has been controversial since it was created. It now covers more than 200,000 Arkansans, but opponents say it’s an unsustainable expansion of Obamacare that the state cannot afford. Gov. Asa Hutchinson has said he will call legislators into special session April 6 to consider his replacement, which he is calling “Arkansas Works.”

O’Leary praised the program.

“Everybody wants Arkansas to succeed and wants to show that you can have flexibility in how you approach it. … Not only does it not have to be, it shouldn’t be kind of Obamacare coming down on high,” O’Leary said. “It should be really smart state solutions, working in partnership with the federal government.”

Hutchinson, who opposes Obamacare even as he uses Obamacare dollars to pay for the private option, has said he would prefer the federal government sending block grants to the states, with the states having flexibility in how they spend the money. Clinton does not favor that approach.

“No, she’s not for block grants, but yes, she is for really thinking creatively and allowing states to experiment so that we can have (Medicaid) expansion in ways that work for the state,” O’Leary said.

Arkansas Works would require more personal and financial responsibility on the part of beneficiaries than the private option. Hutchinson had wanted to include some type of work requirement, but the Obama administration won’t grant that waiver. O’Leary was noncommittal when asked about Clinton’s position on that issue.

“I think she wants to roll up her sleeves and be creative and be flexible and work with states,” she said.

O’Leary, a Maine native, has a long history with Clinton. She worked for White House deputy counsel Bruce Lindsey in 1994 after graduating college, and, after graduate school and a job at the U.S. Department of Education, became Clinton’s policy director while she was first lady. She then served as Clinton’s legislative director when she was in the Senate.

She said Clinton is the only presidential candidate defending the Affordable Care Act. Her primary opponent, U.S. Sen. Bernie Sanders, I-Vt., supports a government-run, single-payer health system. Republicans have said they would repeal and replace Obamacare, though they haven’t said what they would replace it with, she said.

O’Leary said Clinton would look for ways to build on the Affordable Care Act, such as lowering currently high deductibles and insurance premiums. Clinton has proposed capping prescription drug costs at $250 a month and providing a tax benefit of up to $5,000 for high out-of-pocket expenses. She also is looking for ways to contain costs.

“We have 18 million people who have health insurance today who didn’t have it before because of the Affordable Care Act,” she said. “I have a child who has some chronic health conditions, and I often think, if he didn’t have the Affordable Care Act and he grows up, he has a pre-existing condition. He would never be able to get health insurance. And there are many parents like me who would never be able to get health insurance without the Affordable Care Act.”

In other health-related issues, O’Leary said Clinton wants to spend $2 billion a year over 10 years on Alzheimer’s research in order to create an effective treatment by 2025, and wants to set aside $10 billion for addiction issues. She also wants to make mental health a more integral part of overall health care.

Clinton’s attempt to enact major health care reform as first lady in 1993 did not lead to universal health coverage, as she hoped. However, O’Leary said Clinton followed that up by helping pass the Children’s Health Insurance Program.

“Even before we passed the Affordable Care Act, 90% of kids already had health insurance in this country because of Hillary Clinton’s advocacy. … I think that it’s an example of her kind of progressive pragmatism, which is that she doesn’t give up. She keeps working at it. She keeps making sure it gets better,” she said.