Clinton Emails Show Senators Feared ACA Costs

Aug. 16--WASHINGTON -- Sen. Claire McCaskill, D-Mo., has long been a supporter of the Affordable Care Act, and remains so today.

But when the massive overhaul of the nation's health insurance system was being debated late in 2009, she and other senators were expressing concerns about its costs to then-Secretary of State Hillary Clinton.

A point person on health care reform in the administration of President Barack Obama told Clinton that "the dirty little secret is that we don't have a lot of good evidence on what works" on cost controls that could pass Congress.

Those concerns are revealed in emails Clinton sent that are among thousands that have been released or leaked during the controversy over Clinton's use of a private email server.

In an Oct. 20, 2009, email to Neera Tanden, then-senior adviser to Health and Human Services Secretary Kathleen Sebelius, Clinton asked for Tanden's "latest prediction on health care," after Clinton described concerns raised during a "dinner with a bunch of women Senators."

The senators included McCaskill and Olympia Snowe, R-Maine; Dianne Feinstein, D-Calif.; Blanche Lincoln, D-Ark.; and Washington Democrats Patty Murray and Maria Cantwell.

Snowe has since retired and Lincoln was beaten in her re-election challenge in 2010 in a landslide, with the Affordable Care Act an issue in that campaign. McCaskill won re-election in 2012, beating her Republican challenger, U.S. Rep. Todd Akin.

In the email, Clinton asks Tanden, who had been a top policy adviser in Clinton's 2008 presidential campaign: "Are you worried about the lack of cost controls in the current bills?

"I had dinner with a bunch of women Senators, including Snowe, who led by Feinstein, Murray, Cantwell, Lincoln and McCaskill all expressed their concerns," Clinton's email said.

Tanden responded by saying she was optimistic that the law would pass, but listed several moderate Democrats and Republicans -- McCaskill was not among them -- whom the administration was worried about in its eventually successful quest to get 60 votes to overcome a Republican filibuster.

But as to costs, Tanden said she was unsure.

"Cost controls, as we all know, is attacked as rationing. So everyone likes to discuss this, including the Administration, but then on the other hand, says they won't touch benefits," she said.

Tanden is now president and CEO of the liberal think tank Center for American Progress.

McCaskill says the email from Clinton describing the private dinner reflects what she was hearing from Missourians at the time. She said Tuesday that overall, the law has been successful, including helping to slow health care inflation.

Republicans continue to attack the Affordable Care Act as not fulfilling promises made when it passed. Republican presidential candidate Donald Trump and down-ballot GOP candidates continue to advocate for its repeal, while Clinton has proposed expanding and improving it.

Asked about Clinton's email, McCaskill's staff this week issued the following statement from her:

"I'm proud of what the Affordable Care Act has accomplished -- bringing quality, affordable health care to more than 200,000 Missourians and millions of Americans.

"When I listened to Missourians during the bill's debate, it was clear any legislation had to keep costs down and increase consumer choice. More than six years later, the law is working -- as health care spending and employer premium increases slow, and as Medicare spending rates decline -- but every law can be strengthened, and this one is no exception.

"That's why I've continued efforts to make the law work better for patients and their employers, like giving states the flexibility to determine the size of their small group markets and ensuring rural states are reimbursed fairly."

McCaskill had raised concerns over cost controls during the debate over the bill, often called "Obamacare," signing a letter with other moderate Democrats in early 2010 urging that aggressive measures be included in the final version.

McCaskill had supported Obama in the 2008 presidential primaries, and she was one of the first to endorse Clinton in this election.

Independent analysis generally gives Obamacare mixed results.

While it has brought millions of Americans into the health insurance system and made insurance affordable through subsidies for many previously without it, promises made by Obama and other advocates that families would be able to keep the plans they had when the law took effect proved to be false.

Premiums and deductibles have risen, in some cases significantly, but not as high as doomsday opponents of the law had projected. Projections of how many people would participate have, in some instances, fallen short, and critics say lower-than-expected participation by young people willing to pay a penalty for not participating threatens the long-term metrics of Obamacare.

Some big health insurers -- the latest being Aetna this week -- have announced withdrawals or pullbacks from the plan's public marketplaces.

Clinton's emails are part of thousands released by Wikileaks or by Clinton herself, as the Democratic nominee faces allegations that her use of a private email server while secretary of state was "extremely careless," in the words of FBI Director James Comey.

On Monday, Missouri Sen. Roy Blunt, a Republican, agreed with Comey that it was possible that foreign governments had gotten access to Clinton's account, and with it, sensitive, classified information.

"I'd be surprised if that information isn't backed up somewhere outside our country by some government you wouldn't want to have it," Blunt said.

Blunt, who faces Democratic Secretary of State Jason Kander in November, has been one of the Senate's most outspoken critics of Obama's health care law, and opposed it when it passed while he was a member of the House.

Kander supports retaining it, but opposes Clinton's expansion plan that includes allowing people over 55 to buy into Medicare.

Kander spokeswoman Anne Feldman said Kander supports "fixing" Obamacare, including "changing the 30-hour workweek used to define a full-time employee, coming up with a cheaper plan for Missourians who don't need medical care, and repealing the Cadillac tax."

The "Cadillac tax," set to begin in 2018, would impose a 40 percent excise tax on the portions of employer health insurance plans that exceed $10,200 for individuals and $27,500 for families. Congress and Obama have already delayed its implementation by two years.

Chuck Raasch --202-298-6880

@craasch on Twitter

[email protected]

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