A look at the presidential candidates' potential impact on hospitals--if they win

As the presidential race continues to lurch forward and has been winnowed down to three (perhaps four) legitimate candidates, it is worth a look at their positions on healthcare and how their views might impact healthcare delivery finance.


Sen. Bernie Sanders

Sanders has advocated "Medicare For All"--essentially expanding Medicare eligibility to every age group as opposed to the current restrictions of Americans older than 65 or the permanently disabled.

Sanders has not called for dismantling the Affordable Care Act (ACA), although under a Medicare For All, it would be presumed many Americans would opt for that form of coverage as opposed to purchasing it through the exchanges. He has also advocated to allow the Medicare program to negotiate bulk drug purchases.

What's good for hospitals and other providers: Every patient who comes in their doors would theoretically have insurance. Drugs might be less expensive, although it remains to be seen whether it would end spot shortages.

What's bad for hospitals and other providers: They would likely have to treat a lot more patients at Medicare rates, which means making due on reimbursements lower than traditional commercial rates.

Hillary Clinton

Clinton does not believe Medicare For All is economically feasible (there have been mixed, mostly partisan opinions on whether this is true). But she hasn't really put forward any ambitious proposals on healthcare. She supports early screening for autism and specialized insurance coverage, as well as additional spending on Alzheimer's prevention.

The ACA would certainly remain in place under a Clinton presidency.

What's good for hospitals and other providers: To date, the ACA has been good for the bottom lines of hospitals and doctor. Providers have been able to treat more insured patients as a result of the law's implementation. That would remain in place.

What's bad for hospitals and other providers: As enrollment gains under the ACA have dwindled, the initial fiscal bump from the reform law has begun to ebb. And the law did not really contain any serious cost controls, meaning the struggle to keep costs down will continue. And while Clinton is not President Barack Obama, enmity toward her and her policies suggest many states that have yet to opt in to the expansion of Medicaid eligibility may continue to hold out, inflicting fiscal pain on hospitals in those states.


Donald Trump

For many months, Trump's healthcare platform included repealing the ACA and replacing it with something apparently as terrific as it was unknown. Just last month, Trump finally clarified his healthcare proposals. They include a repeal of the ACA, the sales of insurance across state lines, mandated price transparency from providers, the ability to import drugs from cheaper markets and block Medicaid grants to the states.

What's good for hospitals and other providers: Not much. With Medicaid block-granted, many states would almost certainly slash payments. With the ACA repealed, many Americans would likely lose their insurance. And with the notion of selling insurance across state lines, the default would likely be to policies with the least and weakest coverage. The one bright spot is that drug costs might decline.

What's bad for hospitals and other providers: The repeal of the ACA.

Sen. Ted Cruz

Cruz is perceived as being to the right of Trump, but his positions are not much different: Repeal the ACA, sales of insurance across state lines, promote catastrophic insurance policies for individuals.

What's good for hospitals and other providers: Not much. The one bright spot would be better insurance coverage for patients who purchased catastrophic health coverage--assuming it is supplementing some other policy they have in place.

What's bad for hospitals and other providers: The repeal of the ACA.

Gov. John Kasich

Kasich is perceived to be to the left of Trump and Cruz. And while his positions are not all that different from theirs, they are more subtle. A repeal of the ACA would be followed by more improvements in primary care and more bundled payments for episodes of care.

What's good for hospitals and other providers: Kasich is one of the few Republican governors to expand Medicaid eligibility in his state, Ohio. His election would probably enable many GOP-leaning states to expand eligibility as well, helping out many hospitals in those states.

What's bad for hospitals and other providers: The repeal of the ACA.

Despite a tumultuous election process, our government tends to make changes incrementally. No matter who gets elected, big changes won't occur overnight. But 15 years from now, the potential healthcare finance landscape could wind up being radically different from one another based on the upcoming four years. – Ron (@FierceHealth)