Health care in the presidential race

October 19, 2016

Health care has not been a central theme in the 2016 presidential election, but it is an area in which the two major party candidates present starkly different visions for public policy. So here is a brief comparison of where each candidate stands based on an analysis by the Kaiser Family Foundation.

In general, Hillary Clinton supports policies that would build on the Affordable Care Act (ACA) while GOP nominee Donald Trump supports complete repeal of the ACA, including the individual mandate to have coverage.

Clinton would make a public plan option available in every state and give people the option of buying into Medicare starting at age 55. She also would invest $500 million annually in outreach and in-person assistance to enroll more uninsured in coverage.

She would authorize the federal government to review and disapprove unreasonable health insurance premium increases in states that do not have such authority, and she would repeal the Cadillac tax.

Clinton would increase premium subsidies in the marketplace so no participant is required to pay more than 8.5 percent of income for coverage. She has also proposed new private plan standards to waive the annual deductible for at least three sick visits per year, limit monthly cost sharing for prescription drugs to $250, and protect against surprise medical bills when patients inadvertently receive care out of network.

And she has also proposed a new refundable tax credit of up to $5,000 to subsidize out-of-pocket health expenses (including premiums in marketplace plans) for all Americans with private insurance.

Trump would replace the ACA’s refundable premium tax credits with a tax deduction for the purchase of individual health insurance.

He would promote competition between health plans by allowing insurers to sell plans across state lines, meaning an insurer licensed under the rules of one state would be allowed to sell coverage in other states without regard to different state laws that might apply.

Trump also would promote the use of Health Savings Accounts (HSA), and specifically would allow the tax-free transfer of HSAs to all heirs.  He would also require price transparency from all hospitals, doctors, clinics and other providers so that consumers can see and shop for the best prices for health care procedures and other services.

On Medicaid, Mrs. Clinton supports maintaining and strengthening the current Medicaid program and financing structure. She would encourage and incentivize states to expand Medicaid by providing states with three years of full federal funding for newly eligible adults, whenever they choose to expand. And she would continue to make enrollment easier and launch a campaign to enroll people who are eligible but not enrolled in coverage.

Mr. Trump supports a Medicaid block grant and a repeal of the Medicaid expansion in the ACA. He has said he would cover the low-income uninsured through Medicaid after repealing the ACA. The House Republican health plan would offer states a choice between a block grant or a Medicaid per capita allotment.

To address drug prices, Mrs. Clinton would allow Medicare to negotiate drug prices, increase generic competition with a menu of proposals to speed up approval of generic drugs, penalize drug companies for unjustified price increases and allow importation of lower-cost drugs from countries with similar safety standards. She also proposes a $250 per month cap on cost sharing for covered drugs; and a rebate program for low-income Medicare beneficiaries that mirrors those in Medicaid.

Mr. Trump supports allowing importation of drugs from overseas that are safe and reliable but priced lower than in the U.S. He also supports greater price transparency from all health providers, especially for medical exams and procedures performed at doctors’ offices, clinics, and hospitals, but does not specify whether this policy would also apply to retail prescription drugs, which typically are not considered services or procedures. (John Flink, WSHA Federal Lobbyist)


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