With the 2016 election just weeks away, it is a good time to look at the healthcare policies proposed by both the Republican and Democratic candidates. Neither candidate has discussed their healthcare policies extensively on the campaign trail, but their websites and Party Platforms give some ideas of what healthcare policies might look like in a Secretary Clinton or Donald Trump administration. You can access their Platforms at: www.demconvention.com/platform and www.gop.com/the2016republicanpartyplatform. Also referenced is: www.donaldtrump.com/positions/healthcarereform. Here’s a summary below.
General Approach The Party Platforms differ considerably on how they approach the issue of healthcare. The Democratic Platform states that healthcare is a right for all Americans. Therefore, the emphasis is on expanded services, coverage, and access all designed to assure that everyone is covered. In contrast, the Republican Platform has a freemarketbased approach to healthcare, offering tax incentives and “information transparency” all designed to promote competition and hopefully lower costs. Also, the Trump position is clear that healthcare coverage should be voluntary. There is no mandate for coverage for businesses or individuals.
Medicare This is the government program that provides healthcare to citizens ages 65 and over. Again, the Parties approach this program differently. The Democratic Platform preserves the present program and proposes to expand it to those ages 55 and older. However, there are few details provided around this expansion. The Republican Platform advocates a funding transition from traditional Medicare to a “premium support” model. There are few details here, but presumably the government would subsidize the purchase of insurance by providing a fixed amount to recipients so they can purchase insurance on the open market. Also, their Platform would set a “more realistic” age for receipt of these premium supports. The exact age is not provided.
Medicaid Program This program is designed to provide health care for Americans living in poverty. The Democratic Platform not only retains this program but also encourages the 19 States that have not expanded their Medicaid programs under the Affordable Care Act (ACA) to do so immediately. In contrast, the Republican Platform and Trump’s reforms propose to eliminate the program as an entitlement. Instead Medicaid would receive an appropriation yearly that would be distributed to States through a block grant mechanism. Their Platform also states that this program will be reduced over time because Republican policies will expand the economy, and private sector jobs (presumably jobs providing health insurance) will be created. Note that this kind of job expansion has not happened. In fact, the opposite has been true. From 1999–2013, jobs providing health insurance decreased from 66 percent of firms to 57 percent (The Uninsured: A Primer. Kaiser Family Foundation, November 13, 2015).
Affordable Care Act (ACA) This program is designed to provide healthcare insurance to those who have no access to health insurance coverage. These individuals purchase insurance through State healthcare exchanges or through the Medicaid expansion program. The Democratic Platform fully supports the ACA. The Platform states that the Party is proud of the program because it has provided insurance coverage to 20 million Americans. The Republican Platform and the Trump reform plan advocate a “repeal and replace” model. That is, repeal the ACA and replace it with a more efficient, marketbased system. The replacement model is sketchy but includes: 1) encouraging States to reduce healthcare regulations, 2) increasing competition by encouraging insurance companies to expand to other States (which they can do now), and 3) increasing tax deductions/credits for insurance and healthcare costs.
Public Option Under a public option, individuals pay the government for healthcare services. The government, in turn, negotiates with healthcare providers to provide those services to the citizens. Neither Party is specifically advocating for this type of program. In fact, the Republican, marketbased approaches discourage more public funding for health care. Their Platform instead recommends more competition among private sector insurers and providers to reduce costs over time. The Democratic Platform does leave the door open for a limited public option in two ways. One is the expansion of Medicare to persons 55 years and older. The second encourages States to experiment with their own public option models under the ACA. This is an incremental change from their previous policy of not supporting the public option. It reflects the influence of Senator Bernie Sanders, who had advocated for a singlepayer healthcare model.
Healthcare costs and cost containment Neither Party offers specifics in terms of reducing healthcare costs. The Democratic Platform is mostly silent. Their emphasis is on expansion of services and coverage. The Republican Platform relies on the marketbased approaches discussed earlier. Their assumption is that competition, deregulation, tax incentives, and information transparency will reduce costs over time.
Under costs, one area where both Parties agree is pharmaceutical drug pricing. Both Platforms state that pharmaceuticals are too expensive. However, how they plan to reduce these costs is not fully discussed. Both Platforms would allow consumers to purchase medications overseas. The Democrats specifically would allow purchases through certified Canadian pharmacies. Also, in the Democratic Platform, Medicare would be allowed to negotiate drug prices something they cannot do now by law.
To summarize, the Democratic Platform is moving toward universal coverage using the programs listed above as the vehicles. Also, there is at least an incremental movement toward a singlepayer system with the proposed expansions of Medicare to cover those 55 years and older, again, reflecting the influence of Senator Sanders. In contrast, the Republican Platform proposes to reverse the present direction of health care by repealing the ACA, and eliminating Medicare and Medicaid as entitlement programs. The country would move back to the private sector model where health insurance was not mandatory, and a market based system would supposedly insure citizens at a reasonable cost. Unfortunately, this approach has never seemed to work that way in the past. Before, the ACA was implemented, 41 million people (16.7 percent) were uninsured and the cost of insurance had skyrocketed (The Uninsured: A Primer, Kaiser Health Foundation, November 13, 2015). We are now at about 10 percent uninsured (Key Facts about the Uninsured Population, Kaiser Health Foundation, October 2015). However, costs remain a challenge and continue to rise (2017 Premium Changes in the ACA Insurance Marketplaces, Kaiser Health Foundation, July 28, 2016). Therefore, both Platforms need to address the cost containment issue more fully.
Healthcare reform is one of many critical issues facing our nation, and the two major Parties offer radically different solutions. If you care about any or all of these issues, make your voice heard in November: Vote.
Tom DeLoe, Ph.D., is a resident of Adams County and a member of the Adams Hanover Healthcare 4 All Task Force.