By Ida Hellander, M.D.
Updated March 22, 2016
In alphabetical order, top 3 GOP candidates, 2 Democrats, and 1 Green:
1. Hillary Clinton
Defends the ACA. Promotes incremental reform. Advocates Medicare drug price negotiation “for high cost drugs.” Would allow drug importation from other countries, cap specialty drug out-of-pocket costs at $250/month, and allow three doctor visits before having to pay deductible. $5,000 tax credit to families with very high medical costs. (C+)
2. Ted Cruz
Proposes to raise Medicare age to 67 and turn the program into a voucher (“premium support” program). Has introduced legislation (“Health care choices act”) to repeal Title I of the ACA only (i.e. the insurance exchanges, tax subsidies, and mandate to buy coverage) but keep everything else intact (i.e. Medicaid expansion, Medicare ACOs, etc.). Would provide tax credits to purchase health insurance. Promotes health savings account and allowing insurers to sell bare bones policies across state lines. (F)
3. John Kasich
Proposes to repeal ACA. Promotes patient-centered medical homes for Medicaid. Promotes payment reform such as “bundled” payments. (F)
4. Bernie Sanders
Supports single payer national health insurance and allowing Medicare to negotiate drug prices with pharmaceutical companies. Opposed to the ACA’s 40 percent excise tax on high-cost private insurance (“Cadillac tax”). Would allow drug importation from Canada. (A)
5. Jill Stein (Green)
Longtime supporter of single payer national health insurance. (A)
6. Donald Trump
Would repeal the ACA. Would block grant Medicaid. Promotes health savings accounts as a way to save money that is exempt from estate taxes. Would allow importation of cheaper drugs from other countries. Promotes sale of insurance across state lines. Supports making health insurance premiums tax deductible and making health care prices transparent. (F)
Sources: Candidate websites, newspaper articles, media quotes, and interviews.
GLOSSARY OF SELECTED HEALTH REFORM TERMS
Voucher proposal for Medicare. Also known as “premium support,” a voucher program would replace Medicare with a defined-contribution or coupon for beneficiaries to apply towards the cost of private insurance. This approach would limit the government’s spending on Medicare, but raise costs for seniors and the disabled. In addition, private insurance plans have overhead seven-fold higher than Medicare, and have raised, not lowered, Medicare’s costs by selectively enrolling the healthy and dis-enrolling the sick. Proposed by Ted Cruz.
Block grant Medicaid. Medicaid is the jointly-funded federal-state insurance program for people with low incomes. Medicaid currently covers about 70 million people for a defined set of benefits. With a block grant, the federal government would give states a lump sum of money and let states determine how to use it. This is worrisome because the Medicaid program is already underfunded and varies substantially from state to state in eligibility standards, coverage, quality, and reimbursement. Proposed by Donald Trump.
Health savings accounts. Health savings accounts are a tax-free way of saving money for health care. In theory they reduce health care costs by making patients prudent shoppers for health care. In practice, patients with high-deductible health plans coupled with HSA’s reduce their utilization of health care across the spectrum of care, including prevention and primary care. A recent study of HSA’s found no evidence that patients shopped for cheaper care. HSA’s are inadequate for the sick and poor, who quickly deplete them. They are mostly funded by the wealthy, who use them as a tax shelter. Proposed by Donald Trump and Ted Cruz.
Sale of insurance across state lines. Permitting the sale of skimpy insurance plans – plans that don’t meet state standards for coverage – across state lines would increase the number of people who are underinsured and for whom an illness or injury could lead to bankruptcy. Insurers can already sell coverage that meets states’ standards across state lines, as proposed by Donald Trump, but they choose not to. The reason the state regulations are in place is to make sure insurers don’t sell worthless coverage, such as coverage that doesn’t cover hospital care, or that takes 50 percent of premiums for overhead, marketing, profit and huge CEO salaries. Promoted by Ted Cruz and Donald Trump.
Dr. Ida Hellander is director of health policy and programs at Physicians for a National Health Program.
Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office.