Harris County Medical Society President
Neurologist and Cofounder, Houston Neurological Institute
For the first time in many years, Texas voters will play a meaningful role in determining each party’s nominee for U.S. president, when they go to the polls along with voters from six other southern states in the “Super Tuesday” primary. There are many issues being debated by the candidates, but I think we owe it to ourselves to understand where the candidates stand on health care. Below is information on the front-runners. For information on other candidates, see the Harris County Medical Society (HCMS) website.
Mrs. Clinton supports maintaining the Affordable Care Act (ACA) but she would make a few changes. Under her plan, patients could visit a doctor three times without it counting towards their annual deductible. Families ineligible for Medicare could receive up to a $5,000 tax credit for out-of-pocket health care expenses. She also would impose a $250 monthly cap on prescription drugs for patients with chronic or serious health conditions. (U.S. News & World Report, “Clinton proposes a series of steps to curb high out-of-pocket health care costs.” Sept. 23, 2015) Her plan would legalize prescription drug imports from Canada. (Huffington Post Canada, “Hillary Clinton calls for legalizing prescription pill imports from Canada.” Sept. 26, 2015) Additionally, she has specific plans to assist autistic and Alzheimer patients. Her core concern seems to be that the consolidation among both physicians/providers and insurers is shifting the balance of power too far away from consumers. (Reuters, “Clinton has ‘serious concerns’ about Aetna-Humana, Anthem-Cigna mergers.” Oct. 21, 2015)
Editor’s Note: Since the initial publication of this piece on the President’s Page of the Harris County Physician Newsletter, Hillary Clinton has announced her continued support for a government-run health plan, commonly called a “public option.” Her campaign website states Mrs. Clinton will work with governors to “empower states to establish a public option choice.”
Senator Sanders has run as an independent candidate in his home state of Vermont. He typically refers to himself as a Democratic socialist. He is now running for president as a Democrat. He supports the ACA but has the goal of creating a single-payer system. In 2013, Senator Sanders sponsored S. 1782, the American Health Security Act of 2013. Modeled on this legislation, as president he would propose:
- A Medicare-for-all single payer health care system;
- Recognition of health care as a human right;
- State flexibility in designing health care programs; and
- Efficiencies through integrated care and implementation of policies to ensure higher quality, better prevention, and lower per-capita costs. (The Wall Street Journal, “Bernie Sanders to Introduce Bill Targeting High Drug Prices.” Sept. 9, 2015)
Not much is known about Donald Trump’s health care plans. In his 2000 book, The America We Deserve, Mr. Trump argued for universal health care. More recently, he has suggested his support for the equivalent of a single-payer plan but one that also would be modeled after the Federal Employees Health Benefits Program. (Donald Trump, “Time to Get Tough.” Washington, DC, 2011: Regnery Publishing) Mr. Trump has been consistent in his call to repeal the ACA. As an alternative to Obamacare, Mr. Trump recommended in 2011 allowing people to purchase health care plans across state lines because “competition makes everything better and more affordable.” (C-SPAN, “Iowa Freedom Summit, Donald Trump.” Jan. 24, 2015). Since 2013, Mr. Trump has continued to argue for the repeal and replacement of Obamacare but has offered few specifics on what he would replace it with, other than to say his plan would cover everyone.
Senator Cruz has been one of the loudest voices in Washington advocating for repeal of the ACA, but he has offered very little in its place. In March 2015, Senator Cruz sponsored S. 647, the Health Care Choice Act, as an alternative to the Affordable Care Act. (CNS News, “Sen. Ted Cruz: ‘I Intend to Make 2016 a Referendum on Repealing Obamacare.’ “ Aug. 4, 2015) According to Senator Cruz’s website, the act “repeals Title I of Obamacare, which includes the law’s most egregious insurance mandates that have caused premiums and out-of-pocket expenses to skyrocket, while degrading the quality of Americans’ health care choices. The Act also amends the Public Health Service Act to provide that insurance policies approved and sold in one state (designated the primary state) may be allowed to be sold in any other state (i.e., secondary state) but only if the health plan and insurer comply with certain basic requirements of the secondary state.” Cruz has said that after repealing the ACA, he would work to pass health insurance reform “to make health insurance personal, portable, and affordable.” (CBS News, “Senate passes Obamacare repeal bill,” Dec. 3, 2015).
According to his official website, Senator Rubio’s three goals in health care are:
- Repealing and replacing Obamacare,
- Allowing individuals to control their own health care choices, and
- Returning control of health policy to the states.
In addition, Senator Rubio wrote an op-ed in Politico in 2015 stating that after repealing the Affordable Care Act, he would:
- Create an advanceable, refundable tax credit that all Americans can use to purchase health insurance;
- Reform insurance regulations to lower costs, encourage innovation, and protect the vulnerable. These measures would include protecting those with preexisting conditions through federally supported, actuarially sound, and state-based high-risk pools. Also, this would include the ability to purchase coverage across state lines and consumer-centered products, like health savings accounts;
- Save and strengthen Medicare and Medicaid by placing them on fiscally sustainable paths. Move Medicaid into a per-capita block grant system, preserving funding for its recipients while freeing states from Washington mandates. While current seniors on Medicare should see no changes to the program, future generations should be transitioned into a premium support system. A premium support model will empower seniors with choice and market competition, just like Medicare Advantage and Medicare Part D already do. (Politico, “My Plan To Fix Health Care.” Aug. 17, 2015)
In his book, America the Beautiful, Dr. Carson proposed having the government oversee catastrophic health care in the same way that the Federal Emergency Management Agency oversees natural disasters.
Although Dr. Carson has expressed a desire to repeal Obamacare, in July 2015, he called its ban on barring people with preexisting conditions from purchasing insurance “one of the very few bright spots in an otherwise horribly written law.” (Washington Examiner, “The one piece of Obamacare Ben Carson would save.” July 23, 2015)
Dr. Carson released his health care reform policy in December 2015. At the core of his platform is the combination of tax-protected “health empowerment accounts” (HEAs) and high-deductible health insurance plans. Dr. Carson explained his concept of HEAs in an op-ed in The Boston Globe on Dec. 15, 2015. According to Dr. Carson, HEAs will be created for every child at birth and will be freely transferable from one family member to another. They will be available to anyone with a valid Social Security number and will be owned by the individual and not by the government or private corporations. The accounts cannot be revoked by job changes or state-to-state relocation. (The Boston Globe, “A prescription for health reform.” Dec. 15, 2015.) Several other features of his plan are:
- A fixed contribution for Medicare beneficiaries to select the insurance plan of their choice;
- The gradual increase of the eligibility age for Medicare to age 70;
- Overhauling Medicaid, giving users private insurance options, which would be funded through state-run Medicaid programs, and seed funds from users’ own health empowerment accounts. (The Huffington Post, “Everything You Need To Know About Ben Carson’s Health Care Plan,” Dec. 9, 2015; The Washington Post, “Ben Carson pitches repealing Obamacare, raising Medicare eligibility age in health reform plan,” Dec. 9, 2015)
On his website (www.johnkasich.com), the Ohio governor offers a few guidelines on his ideas for a better health care system. First, and foremost, he wants to repeal and replace the ACA. His replacement model would focus on patient-centered care, choices, market competition, decentralized decisionmaking, higher quality, respect for individuals, and an end to big government interference. It is important to note that while Governor Kasich opposed the ACA, he supported an expansion of Medicaid in his state of Ohio. The Ohio General Assembly tried to prevent the governor from passing the Medicaid expansion, but Governor Kasich circumvented the state legislature and passed the expansion despite protests.
This is by no means an exhaustive discussion of the candidates’ positions on health care, but it should give you a good start. I encourage you to do more research on the candidates you are considering. I encourage you to cast your vote in the March primary. Early voting runs through Feb. 26.
First published at http://www.hcms.org/2-15-16_Physician_Newsletter/#Presidents_page