Improving Healthcare

Claire joined the Senate with a pledge to Missouri's families to finally tackle the country's broken health care system - a system that was contributing to budget-busting deficits, leaving millions of Americans without access to quality care, and subjecting millions more to the abusive practices of big insurance companies.

In the years since, Claire made good on that promise. She voted to expand the State Children's Health Insurance Program (SCHIP) to offer coverage to more Missouri kids. She helped to pass sweeping health care reform that is already working to protect families from insurance industry abuses, slow the growth of health care costs, and expand coverage to millions of Americans. She has worked to increase transparency in medical pricing, believing that doing so can unleash the power of consumers to help control costs.

And Claire has established herself as a leader in the fight to protect Medicare - opposing attempts to privatize the program and transform it into a voucher system, while using her oversight work to successfully target waste, fraud, and abuse that endanger the program's benefits to seniors.

Need for Comprehensive Reform:

"Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection." --Harry Truman, 1945

By 2009, Claire believed our nation was facing a healthcare crisis. Families without insurance were forced to file for bankruptcy as a result of medical bills. Patients were denied insurance because of preexisting medical conditions, or were kicked off of their insurance policies when they became sick. The uninsured were getting health care through their emergency room, with the insured picking up the tab. The average cost of insurance had ballooned by more than 130 percent since 1999. This burden had been stretching the finances of families, hurting the profitability of employers, and causing our national deficit to explode.

  • In 2009 nearly 20 percent of all federal spending ($676 billion) was on the two major federal healthcare programs of Medicare and Medicaid.
  • In the eight years prior, health insurance premiums had grown four times faster than wages.
  • In 2007 62 percent of bankruptcies were tied to medical debt.
  • Nearly 750,000 Missourians did not have health insurance.

Claire argued that the status quo was unsustainable and jeopardized the health of Missouri's citizens and the health of our economy. She supported the Affordable Care Act (ACA), which put into place reforms that are strengthening the quality of care in the United States and taming the out-of-control increases in the costs of medical care that have been common over the past decade.

The ACA was approved by the U.S. House and Senate (with a supermajority of Senators), signed by the President, and was since upheld by a conservative Supreme Court.

While the debate around this law was often controversial and viewed as partisan, the President's fiscal commission made up of both Democrats and Republicans endorsed many of the changes made by the ACA and actually encouraged that implementation of some of the provisions be sped-up in order to realize savings more quickly.

Passage of the law was supported by the American Medical Association, the American Hospital Association, the American Cancer Society, AARP, the Consumer's Union (Consumer's Report), and the Catholic Health Association.

What is in the Law?

Click here for a Fact Sheet debunking the top 10 myths of health care reform.

  • Pre-existing conditions: The ACA bans the practice of refusing to issue insurance based on a patient's pre-existing condition. This happens in two phases. The first phase is already in effect, which bans discrimination against children under 18 years of age. The second phase for adults will occur in 2014. In the meantime, every state has set up a pre-existing condition insurance pool where adults with pre-existing conditions who have been without insurance can purchase insurance that is subsidized so that it is no more expensive than the average person pays. Information on the program in Missouri can be found at
  • Rescissions banned: The practice of rescission, which is when an insurance company drops coverage for a person after becoming sick, has been banned.
  • Young adults able to stay on parent's plan: Young people can now stay on their parent's health insurance plan until their 26th birthday if they do not have access to their own employer-sponsored coverage.
  • Small business tax credits: The new law also provides benefits to small businesses that want to provide health insurance to their employees but have not been able to afford it. The law provides tax credits to employers with fewer than 25 employees whose average salary is less than $50,000 per year and who pay at least 50 percent of their employees' health insurance premiums. From 2010 through 2013 employers can claim a tax credit for up to 35 percent of their contribution toward employee premiums. This value jumps to 50 percent in 2014 and 2015. Further information on employer responsibility and small business tax credits can be found by clicking here.
  • Access to affordable insurance: In 2014, each state will have access to an insurance exchange where uninsured Americans can shop for affordable insurance and choose from a variety of plans. These exchanges are not a form of government insurance, but rather are comparable to sites like OrbitzTM or TravelocityTM. On the exchanges, private insurance companies will be able to offer their insurance and customers will be able to compare policies and prices on an apples-to-apples basis. Not only will individuals be better able to compare prices between private carriers, the exchange will also allow businesses with less than 50 employees (up to 100 at a state's discretion) and individuals to pool their risk and have the same kind of purchasing leverage that, previously, only large companies had. Missourians are not required to use the exchange. In fact, just as before reform, most Missourians will continue to get their insurance through their employer. The only people required by law to purchase their insurance through the exchange are members of Congress and their staffs.
  • Paying for healthcare - not bureaucracy: Insurance companies are now required to spend at least 80 percent of their revenue on medical care rather than marketing, administration and profits. When an insurance company allots too much to their profits and administration costs, they must issue rebates to their customers. The ratio of medical expenses to premiums received is known as the "Medical Loss Ratio." More info can be found by clicking here.
  • Appeals process: Insurance plans now have to implement an appeals process that allows beneficiaries who have had a claim denied to appeal those decisions. States are also given assistance to help create this appeals program.

Medicare Reforms to Better Serve our Nation's Seniors

Medicare has been the foundation of health insurance for our nation's seniors since 1965 and has provided a crucial health care safety net for nearly 45 million elderly Americans. Claire knows how important Medicare is for seniors living on a fixed income, and she is committed to strengthening this vital benefit program. Before passage of the ACA, it was estimated that Medicare would run out of money by 2017, and there was growing concern the federal government would not be able to keep pace with the aging baby-boomer demand for medical services. In the new healthcare reform law, every guaranteed Medicare benefits was protected, and many new benefits have been added. Several of the major changes in Medicare are listed below.

  • The ACA adds several new benefits to seniors on Medicare, including an elimination of cost sharing for preventive visits for services like mammograms and colonoscopies. Additionally, Medicare beneficiaries can receive an annual wellness visit with their doctor at no cost.
  • The Medicare Part D "Doughnut Hole," is now closed thanks to the ACA. Seniors reaching this coverage gap in 2010 received a $250 rebate check, and in 2011, name brand drugs began being offered to beneficiaries in the gap at a 50 percent price discount.
  • Medicare will move toward rewarding quality of care with bonuses for the best providers and bundling of payments rather than the current system which rewards volume of care.
  • The Medicare Advantage program, which was conceived in order to save Medicare money, actually costs 14 percent more than traditional Medicare. Under the health reform law, private plans will have to deliver on their promise to save the government money, as their taxpayer-provided subsidies will slowly be phased out. Regardless, all Medicare beneficiaries will continue to have access to Medicare and all of their guaranteed benefits. Some have labeled these reforms as a cut to Medicare and sought to use them in political attacks, but this reform is in fact one supported by both Republicans and Democrats. It was included not just in the ACA but also in the budget proposed by U.S. House Representative Paul Ryan (R-Wis.) and approved by the House of Representatives. The reform prevents private companies from making unreasonable profits at the expense of taxpayers, while ensuring Medicare beneficiaries continue to receive every benefit guaranteed in law.

ACA Going Forward

The ACA has now been upheld by a conservative Supreme Court and is the law of the land. Claire acknowledges that no law is perfect, and is committed to continuing to improve the reform law as it is implemented.

First, she joined with her Republican colleagues to successfully remove a burdensome reporting requirements placed on businesses. Under the problematic provision, businesses would have needed to file forms to the IRS for every vendor with which they have at least $600 in transactions for purchases of goods. While this provision had been proposed by Senators on both sides of the aisle, Claire argued that it placed undue stress on small businesses, especially as our economy continues to recover. She has also teamed up with Republican Senator Tom Coburn of Oklahoma, to seek to repeal a provision in the law that has proved problematic, by causing some states, including Missouri, to subsidize high wages at hospitals through Medicare reimbursements.

Claire is also frustrated by exemptions that health insurance companies have from antitrust laws and had hoped that this would have been corrected during reform. Competition is healthy for businesses, and Claire feels that insurance is no different. Claire is working to see this issue addressed in future legislation.

The implementation of the ACA occurs in steps over the course of the coming years and will involve new guidance from the Department of Health and Human Services. Claire will carefully monitor the law's progress in the coming years and weigh in where appropriate to protect Missourians from insurance company abuses. A brief timeline is listed below, but for a full timeline please visit


  • Immediate Access to Insurance for Uninsured Individuals with a Pre-Existing Condition.
  • Eliminating Pre-Existing Condition Exclusions for Children.
  • Prohibiting Rescissions.
  • Extending Dependent Coverage to age 26.
  • Reducing the Part D "Donut Hole" or Coverage Gap with a $250 rebate for seniors entering the "hole."


  • Wellness benefits in Medicare
  • Insurance companies required to spend 80-85 percent of premiums on healthcare or more
  • Prevention Benefits in Medicare


  • State-based insurance exchanges where consumers can shop among private plans and affordability tax incentives available for lower-income Americans
  • Guaranteed issue of insurance - no one can be denied based on pre-existing conditions
  • Continued closure of the Medicare Part D "Doughnut Hole"

Protecting Medicare

In addition to ACA reforms, Claire has consistently opposed efforts seeking to transform Medicare into a voucher system, saying in 2012, "Too many members of Congress who told us they'd focus on job-creation, instead seem willing to pull the rug out from under Missouri's seniors in order to reward corporations and the richest Americans. They need to drop their obsession with turning Medicare into a voucher program and start finding ways to put more Americans back to work."

Believing that waste, fraud, and abuse in the Medicare system endanger benefits for America's seniors, Claire has also used her Chairmanship of a key Senate oversight panel to investigate aggressive sales and marketing tactics in the medical equipment industry, and improper billing to the Medicare system. One of Claire's investigations was launched in part because of a letter she received from a Missouri doctor, asking the Senator to investigate medical device companies who had "badgered" patients and submitted prescription requests for equipment that the patients did not ask for.

Rural Health Care

As a daughter of rural Missouri, Claire strongly believes that Missourians in rural communities deserve the same access to quality healthcare as those living in urban areas.

The ACA dramatically expands tele-health programs so that communities in rural Missouri can have more and better health care options.

In addition to ACA reforms that will expand access in rural Missouri, Claire also backs bipartisan legislation to renew Medicare programs that are critical to rural communities and Medicare patients.

And Claire supports the Rural Hospital Access Act, which would extend Medicare payment programs that are critical to the health of rural hospitals throughout the country. Specifically, the extension of the Medicare-Dependent Hospital program and the Low-Volume Hospital Program provided for in the bill would save Missouri hospitals millions of dollars annually, and allow rural hospitals to provide vital services to Medicare beneficiaries within their own communities.