Speeding to November, the 2016 presidential race continues on. For the Democratic party, Hillary Clinton continues to show a slight dominance over Bernie Sanders with her win in Nevada though Sanders did win the New Hampshire primary. For the GOP party, Jeb Bush recently forfeited his campaign as Donald Trump continues to advance as the potential Republican nominee, for better or worse depending who you talk to and what they are willing to admit.
Some of the presidential candidates have presented a plan for the future of healthcare in the country, while others have only briefly discussed their stances on industry issues or dodged questions completely. How defining of an issue healthcare will play in the elections is yet to be seen, but here is what Healthcare Dive knows about the ideologies of the leading candidates so far.
The healthcare issues Democratic candidates have primarily focused on include the Affordable Care Act, drug pricings, reproductive and mental healthcare. Unsurprisingly, the presidential hopefuls say they would uphold the ACA, even though critics say Bernie Sander’s plan to establish a single-payer system would in fact require the 2010 law to be repealed. Both Clinton and Sanders have stressed that healthcare is a basic human right.
Last month, Clinton told AOL.com, "We are 90% covered, we gotta get to 100%, and then we gotta get cost down and make it work for everybody. And even though we didn't get it then, we've got it now and I'm going to defend it and improve it."
The former U.S. Secretary of State, Clinton has proposed to build on the ACA to reduce out-of-pocket and drug costs. She has said she would defend the law from any efforts to repeal it, though she did appeal to Congress to repeal the controversial Cadillac tax, due to kick in 2020, which seeks to address healthcare overconsumption yet critics have deemed it a problematic policy. Additionally, she believes Medicare should have the authority to negotiate for all drugs and pushback against drug companies that ask for really high prices.
Clinton is the only candidate that has expressed concerns about megamergers between health insurers, such as the proposed Aetna/Humana and Cigna/Anthem mergers.
Her main objective would be to establish a universal healthcare system. Single-payer will “never, ever pass,” she told an Iowa crowd. She also has proposed to exempt three doctor's visits a year from insurance deductibles, provide a refundable tax credit of up to $2,500 for individuals and $5,000 for families for people who spend more than 5% of their income on out-of-pocket healthcare expenses, and modify unreasonable insurance rate hikes.
In September 2015, Clinton released her healthcare and prescription drug plan, which included stopping direct-to-consumer drug company advertising subsidies and reinvesting in research, requiring drug companies that benefit from taxpayers’ support to invest in research, and capping monthly and annual out-of-pocket costs for prescription drugs.
This week, Politico reported the Clinton campaign has updated her website to show backing for a public option.
As president, Clinton stated she would continue her efforts to ensure women have access to reproductive healthcare and defend Planned Parenthood.
While Sen. Bernie Sanders' (I-VT) single-payer healthcare system, which would give the government leverage to lower drug prices, might in theory be popular, critics say the numbers in his plan do not add up.
Gerald Friedman, an economics professor at the University of Massachusetts-Amherst, said Sanders’ healthcare plan could help increase wages and dramatically reduce the country’s poverty rate. In an open letter, four Democratic economists criticized Sanders’ plan. “As much as we wish it were so, no credible economic research supports economic impacts of these magnitudes,” the economists wrote.
In September 2015, Sanders, along with Rep. Elijah Cummings (D-MD) pushed for a bill called the Prescription Drug Affordability Act of 2015 that would give Medicare the authority to negotiate for all drugs, and the ability to import cheaper drugs from Canada. A congressional committee is considering the bill before sending it to the House or Senate.
If he takes office, he stated he plans to pay for the establishment of the “Medicare-for-all system,” which he estimates will cost about $1.38 trillion annually, by raising taxes. Sanders also wants to eliminate private health insurance premiums, deductibles, and cost-sharing, which he says would result in more than $5,000 in savings each year for the average family.
He says his plan would “cover the entire continuum of healthcare, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral healthcare; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments.”
If a Republican candidate is elected, the ACA will most likely be on the chopping block as every candidate has said repealing the measure would be a priority. However, this process is likely to be lengthy and costly.
“Obamacare's going to be repealed and replaced,” Donald Trump said during an interview on 60 Minutes in September 2015. “Obamacare is a disaster if you look at what's going on with premiums where they're up 45, 50, 55%.”
According to an analysis done by the National Conference of State Legislature, the national average marketplace premiums did not increase from 2014 to 2015 and Alaska was the only state that saw an increase of more than 30%.
Donald Trump, real estate mogul and television personality, says he would replace the ACA with a market-based alternative. However, he said he liked the individual mandate last week during an interview with CNN’s Anderson Cooper. He has endorsed a healthcare system in which insurance companies can offer plans across state lines.
He agrees with Sanders and Clinton in allowing Medicare to negotiate for drugs, which he said could save $300 billion per year. Yet critics say his claim was overstated because the savings goal would exceed what the country spent on prescription drugs in 2014 - $298 billion. Trump rejects the idea of a single-payer healthcare system, though he once publicly expressed support for it during a Fox News Republican debate last year.
Trump, who would be in charge of the CDC and NIH if he were to become the next president, has publicly stated that vaccines have links to autism and while he supports vaccines, he says he wants “smaller doses over a longer period of time.”
“For the second time in just a few years, a handful of unelected judges has rewritten the text of ObamaCare in order to force that failed law upon millions of Americans,” Sen. Ted Cruz (TX) said during a speech on the Senate floor last year.
In 2014, Cruz also said he would repeal the ACA if not in 2015 then by 2017 after President Obama leaves office on ABC’s This Week. Like Trump, he stated he would establish a system allowing insurers to sell plans across state lines, though some states already allow such sales - Georgia, Maine, and Wyoming. Cruz also favors expanding health savings accounts, and delinking health insurance coverage from employment “so if you lose your job, your health insurance goes with you, and it is personal, portable and affordable,” he said during a Republican presidential debate in Iowa last month.
His 2015 bill, the Health Care Choice Act, sponsored by Sens. John Barrasso (R-WY), Mike Crapo (R-ID), David Vitter (R-LA), and Marco Rubio (R-FL), would prohibit insurers from reclassifying enrollees or hiking their premiums based on health status or claims experience. But the bill, introduced last March, would allow insurers to cancel coverage lines and raise rates for all policyholders in a class. It is currently being evaluated by a congressional committee. Cruz has also advocated for cheaper insurance plans high deductibles.
“ObamaCare is fatally flawed not just because it is poorly constructed, but because it relies on the outdated philosophy that the federal government can solve our problems through more spending, more taxes, more regulations, and more bureaucrats,” Rubio wrote in Politico in August 2015.
Since Rubio became a U.S. senator, he has fought against ACA. If he were to win the White House, he says he would make repealing and replacing ACA “an urgent priority.”
In 2014, Rubio said in an interview on CBS’ Face the Nation Medicaid expansions fail because they are only funded for a few years so he would take the federal funding that is currently used for these programs, and collapse them into one federal agency that would fund state programs addressing the same issues.
Rubio presented a plan for healthcare with three main components:
Working with Congress to create an advanceable, refundable tax credit that all Americans can use to purchase health insurance;
Reforming insurance regulations to lower costs, encourage innovation, and protect the vulnerable; and
- Saving and strengthening Medicare and Medicaid by placing them on fiscally-sustainable paths.