It shouldn’t surprise anyone that with the unprecedented polarity between the political parties, the potential for the presidential election to impact healthcare policy is significant. The following is an outline of where the candidates stand and what is likely (or not) to happen depending upon who prevails.
Donald Trump:
Trump’s first priority if elected is to ask Congress to repeal President Barack Obama’s signature law, the Affordable Care Act, with its many controversial and sometimes contradictory provisions. What he would like to replace it with is consistent with many prior Republican “free market” initiatives that include:
- Eliminate the individual/employer mandate and make the purchase of healthcare insurance optional
Challenge: This will concentrate the risk pool and potentially increase the cost of insurance coverage for all
- Minimize restrictions on enabling insurers to offer insurance products across state lines
Note: Most agree that payer competition is beneficial and is one of the primary features of the ACA through the creation of insurance exchanges or markets
- Allow individuals to fully deduct healthcare insurance premiums from their federal taxes
Note: Most agree that this is positive, although it will decrease general revenues
- Enable all individuals to use healthcare savings accounts that are tax free and permitted to accumulate indefinitely
Note: Most agree that HSAs are an important reform to more fully engage consumers and beneficiaries
- Require price transparency of all healthcare services
Note: Both parties agree that transparency in both price and performance is key
- Convert Medicaid to block grants to states that adjust for inflation
Challenge: This will cap Medicaid, which may put the highest risk (and cost) individuals at risk, driving up the costs (through cost shifting) for healthier individuals
- Enable Americans access to pharmaceuticals produced overseas to control prices
Note: Most agree that global competition is inevitable and will raise the bar for both the pharmaceutical industry and consumers
- Eliminate healthcare support for illegal immigrants
Note: This is a politically divisive topic, as many of these individuals contribute to the economy and will drive up healthcare costs (through cost shifting) if they system is not permitted to treat illnesses at an early stage
- Reduce the number of Medicaid and CHIP enrollees through job creation and economic stimulation
Note: This is generally agreed upon as sound economic policy by both parties
Many of these ideas are in strong alignment with major employers and their drive to significantly reduce costs while optimize healthcare outcomes through the creation of narrow and tiered networks as part of a market-based approach.
Hillary Clinton:
Clinton will protect and preserve Obama’s legislative legacy by modifying the problematic areas of the ACA while preserving its original intent to increase the number of insured Americans, create more open markets within the insurance industry, extend the solvency of Medicare and move the country away from fee-for-service reimbursement. Bernie Sanders’ surprisingly strong populist run has altered her stance on healthcare policy, particularly with regard to the first initiative:
- Expand Medicare by enabling individuals to “buy into” the program at an earlier age if desired (the public option)
Challenge: This will lower the overall costs of Medicare with low-risk individuals and will raise the cost of Medicare with high-risk individuals, so its economic impact is uncertain and may be problematic
- Maintain the individual/employer mandate
Note: The intent of this policy is to minimize the overall cost of the risk pool as higher-risk individuals tend to purchase insurance by choice to avoid personal financial risk while lower risk/cost individuals do not
- Reduce out-of-pocket healthcare expenditures through creation of a tax credit of up to $5,000 per family for any healthcare costs (including premiums) greater than 5 percent of income
Note: Both parties agree on greater federal subsidies (tax credits or deductions) for healthcare costs, even though it will decrease general revenues
- Incentivize states to expand Medicaid for those most in need
Challenge: This is a divisive issue and has become a flashpoint regarding how much control the federal government should have in exchange for its subsidy of state-managed healthcare programs. Many states are moving toward some form of managed Medicaid (e.g. Oregon’s coordinated care organizations) to further engage beneficiaries in order to optimize quality and reduce costs among the nation’s highest cost/risk individuals.
- Expand access of healthcare services regardless of immigration status, sex or sexual orientation
Challenge: This is another divisive flashpoint and separates those with strong moral and ethical convictions regarding: immigration, abortion and LGBT rights
- Reduce the cost of prescription drugs and durable medical equipment through global competition
Note: This is a point of agreement between both parties--pharmaceutical costs must come down and be competitive with those marketed overseas.
Many of these ideas share a more free market approach while expanding the role of the federal government to protect and expand the healthcare access of individuals and protected groups from alleged discriminatory policies and state statutes.
In conclusion, this is an important election, as the polarity of Congress is reflective of the nation. The implication for policy change is significant based upon which individual will prevail in November and how the balance between the parties within Congress will evolve and shift over time.