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By Matt O’Connor for (H&HN) Hospitals & Health Networks
Here are the 8 presidential election candidates’ stances on health care, taken directly from their websites.
Jeb Bush:
ObamaCare is a government takeover of more than one-sixth of the American economy, and it epitomizes why Americans are so fed up with Washington. To win on repeal, conservatives must unite around a vision of health care for the future – one that enables transformational innovation. Governor Bush’s plan would repeal ObamaCare and accomplish three things:
- Promote innovation
- Lower costs
- Return power to states
1. Promote innovation in health care
Health care costs grow faster than any other sector of the economy and innovation lags. Why? Washington over-regulation in health care creates high barriers to entry, adds excessive costs, fosters excessive complexity and impedes innovation. Governor Bush will:
Modernize the Food and Drug Administration’s regulatory morass and increase funding and accountability at the National Institutes of Health
Promote private sector leadership of health information technology adoption and enable better access to patient de-identified Medicare and Medicaid claims data
Establish a comprehensive review of regulatory barriers to health innovation
2. Lower costs and enable portable, secure coverage for all Americans
Until health care is oriented around consumers, providers and innovation, Americans will not get better value and results out of the health care system. In addition, coverage options must reflect a modern, 21st century workforce where workers frequently switch jobs or start new businesses and need the security of portable coverage.
It is critical to have a well-functioning individual market side-by-side with a strong employer-sponsored coverage market. The employer health insurance market represents a strong and innovative coverage platform for 154 million Americans. To improve coverage, Governor Bush will:
Provide a tax credit for the purchase of affordable, portable health plans that protect Americans from high-cost medical events
Increase contribution limits and uses for Health Savings Accounts (HSAs) to help with out-of-pocket costs
Facilitate transparency on costs and outcomes
Cap the employer tax exclusion to lower insurance premiums
Allow employers to use financial incentives to encourage wellness programs
Enable small businesses to make tax-free contributions to their workers’ individual, portable health plans
3. Take health care control out of Washington and return it to states
States should have responsibility, freedom and accountability to make their individual insurance markets more competitive, enhance access to care and design solutions for vulnerable Americans. Instead of Washington standardization, this approach emphasizes transparent outcome standards. States will have streamlined, capped federal funding and be responsible for meeting transparent metrics to:
Make their insurance markets more competitive. This will include enabling access to affordable, catastrophic plans in their states; a continuous coverage guarantee for individuals with pre-existing conditions; access to affordable care and improved health outcomes in their state; lower health care cost growth, including medical liability reform; and a transition plan for the 17 million individuals entangled in ObamaCare.
Strengthen the health care safety net. To achieve this, states may use a number of strategies: individualized, community-based benefit designs; coordinated care for individuals with behavioral health conditions and the disabled; tailored care delivery to reflect the diversity of state populations; personalized care solutions for high-risk individuals with proven data analytics; work requirements for able-bodied individuals; premium assistance for individual and employer-provided coverage; and consolidated funding from various programs to better coordinate care.
Ben Carson:
Website
A lifetime in medicine taught me that the best health care decisions are made between patient and doctor. As decision-making moves further away from patients and providers, the medical outcomes become less effective.
Obamacare has upended the patient-doctor relationship, restricting our health care options and access to doctors and specialists. As a result, patients face exorbitant increases in premiums, deductibles and co-pays, less access to the doctors they trust and fewer health care plans to choose from.
Fewer choices — Already, 5 million Americans have been kicked off the private health care plans they depended on, with 21 percent fewer health plan options than before Obamacare.
Fewer doctors — Even now, specialists essential to diagnosing and treating stroke (America’s 5th leading killer) are in severe shortage under the Obamacare insurance plans.
Broken promises under Medicare & Medicaid — Medicare and Medicaid beneficiaries face a two-tiered health care system, as many doctors can no longer afford to participate; meanwhile, both programs are unsustainable.
Repeal the Affordable Care Act and put “We the People” in charge
Health Empowerment Accounts to put patients in charge, with more choices at lower cost:
First-dollar coverage for out-of-pocket expenses and premiums to buy the insurance of your choice.
Your Money. Your Account belongs to you, whether you change jobs or cross state lines.
Transferable between family members, because each of us has different medical needs.
Give Medicare beneficiaries a fixed contribution to buy the health insurance they actually want and need.
Give Medicare and Medicaid enrollees HEAs to cover first-dollar expenses and insurance premiums for coverage they get to choose
Modernize Medicare to keep pace with medical advances by gradually increasing the eligibility age (by 2 months each year) until it reaches age 70.
Give Medicaid beneficiaries the same insurance coverage, doctors and choices that other Americans enjoy, with HEAs to provide first-dollar coverage, supplemented by a major medical insurance plan of the patient’s choice.
Save Medicaid by providing fixed-dollar support to the states, which must use the funds for premium payments and HEAs for beneficiaries.
Hillary Clinton:
Hillary led the fight to expand access to quality, affordable health care for decades—and she’s not going to stop now. Throughout her career, Hillary led the fight to expand health care access for every American:
In 1979, Hillary chaired the Arkansas Rural Health Advisory Committee, which focused on expanding health care access to isolated rural areas of the state.
As first lady, she refused to give up when Congress defeated health care reform. Instead, she worked with Republicans and Democrats to help create the Children’s Health Insurance Program, which now provides health coverage to more than 8 million children. Senator Ted Kennedy said that if not for Hillary, the Children’s Health Insurance Program wouldn’t be in existence today.
As senator, she introduced legislation to reduce the cost of health insurance expenses.
Following the terrorist attacks of September 11, 2001, Hillary pushed the Bush administration for $20 billion for recovery and to address health care needs of first responders who suffered lasting health effects from their time at Ground Zero.
- Hillary will continue to defend the Affordable Care Act (ACA) against Republican efforts to repeal it. She’ll build on it to expand affordable coverage, slow the growth of overall health care costs (including prescription drugs).
- Lower out-of-pocket costs like copays and deductibles. The average deductible for employer-sponsored health plans rose from $1,240 in 2002 to about $2,500 in 2013. Hillary believes that workers should share in slower growth of national health care spending through lower costs.
- Reduce the cost of prescription drugs. Prescription drug spending accelerated from 2.5 percent in 2013 to 12.6 percent in 2014. Hillary believes we need to demand lower drug costs for hardworking families and seniors.
- Transform our health care system to reward value and quality. Hillary is committed to building on delivery system reforms in the Affordable Care Act.
Hillary will also work to expand access to rural Americans, who often have difficulty finding quality, affordable health care. She will explore cost-effective ways to broaden the scope of health care providers eligible for telehealth reimbursement under Medicare and other programs, including federally qualified health centers and rural health clinics. She will also call for states to support efforts to streamline licensing for telemedicine and examine ways to expand the types of services that qualify for reimbursement.
Hillary is continuing a lifelong fight to ensure women have access to reproductive health care. As senator, she championed access to emergency contraception and voted in favor of strengthening a woman’s right to make her own health decisions. As president, she will continue defending Planned Parenthood, which provides critical health services including breast exams and cancer screenings to 2.7 million women a year.
Ted Cruz:
Since Sen. Cruz took office, he has been a leading voice for repealing Obamacare. In fact, the first piece of legislation he filed, co-sponsored by 32 Republicans, was to fully repeal Obamacare.
Before the law went into effect in January 2014, Sen. Cruz led the effort to halt its implementation and defund Obamacare, filibustering it on the floor for an historic 21 hours.
Obamacare is causing millions to lose their jobs, be forced into part-time work, lose their doctors and health insurance, and pay skyrocketing premiums. This law isn’t working. Instead, Congress should repeal Obamacare and make meaningful reforms to expand Health Savings Accounts, allow individuals to purchase insurance across state lines, and make health care more personal, portable, and affordable.
Since Obamacare’s implementation, Sen. Cruz has opposed the law’s unconstitutional mandates. He authored an amicus brief supporting Hobby Lobby and Conestoga Wood Specialties against the contraception mandate that forced individuals to either violate their conscience or pay crippling fines. In the summer of 2014, the Supreme Court ruled in favor of religious liberty and upheld the right of small business owners to operate in accordance with their beliefs.
Cruz will lobby Congress to repeal The Affordable Care Act and make meaningful reforms to expand Health Savings Accounts, allow individuals to purchase insurance across state lines, and make health care more personal, portable, and affordable.
He authored an amicus brief supporting Hobby Lobby and Conestoga Wood Specialties against the contraception mandate that forced individuals to either violate their conscience or pay crippling fines. In the summer of 2014, the Supreme Court ruled in favor of religious liberty and upheld the right of small business owners to operate in accordance with their beliefs.
John Kasich:
Obamacare is the Wrong Diagnosis and Must Be Repealed and Replaced: Access to affordable health insurance is an important priority but Obamacare has failed to achieve this because it has driven up the cost of health insurance approximately 80 percent in Ohio’s individual and small group market and raised taxes to help subsidize health insurance coverage for families making up to $94,000 annually. Too often Obamacare mistakes treating symptoms for solving problems which only worsens the overall, long-term problem. John Kasich believes Obamacare must be repealed and replaced with efforts that instead improve access by actually lowering health care costs without interfering with Americans’ personal health care decisions or imposing punishing burdens on job creators.
The Real Problems Remain Unchanged: Americans get what we pay for in health care, and too often what we pay for is more care instead of better care. In many areas a predominantly fee-for-service system creates financial incentives for health care providers to perform more services for a person who is sick rather than work to keep that person healthy. As a result, an estimated one-third of America’s health care dollars are wasted on things patients don’t need (IOM 2009) and, at the same time, 55 percent of Americans have been found to go without recommended treatments for preventive care and chronic care management (NEJM 2003). The time has come for leadership to fix it.
A New, Conservative Vision: In Ohio, health care purchasers, health insurance plans, and providers realize the current system is unsustainable and are working–together with Gov. Kasich’s Administration–to explore new payment models that, instead of just rewarding volume, reward value that helps people stay healthier.
Better primary care (patient-centered primary care): The first step is having a primary care system that helps promote long-term good health instead of just reacting when someone gets sick. Ohio is working through its Medicaid system to encourage patient-centered primary care practices that go the extra distance to keep people healthy and thereby help control costs. Savings generated this way accrues, in part, to health insurance plans as avoided costs.
Rewarding value instead of volume (episode-based payments): Even with primary care payment reform, high-cost episodes will continue to account for most health spending. Today we pay for all of the inputs in these episodes separately, but if these inputs were considered as a whole then the providers involved would, similarly, work as a team to control costs and maximize quality. Many providers are actually doing this today but the savings only accrue to the health insurance plan, not the high-value provider who generates it.
We must return control of health care choices to patients and return full control of insurance market regulation to states. In doing so we will help more Americans get and stay healthy in a high-quality and affordable way that sustainably supports our country’s long-term economic growth.
The Path Forward: Everyone knows that Obamacare must be repealed and replaced with something that actually works in line with America’s market-based principles to help Americans be healthy. So, let’s not only oppose Obamacare but also put in motion real solutions that will work to improve health care access by holding down costs and help Americans live healthier lives. The Ohio model provides a path forward for the nation: patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals and an end to Obamacare’s big government interference.
Following the principles that have long served America well means returning control of health care choices to patients and returning full control of insurance market regulation to states. In doing so we will help more Americans get and stay healthy in a high-quality and affordable way that sustainably supports our country’s long-term economic growth.
Marco Rubio:
ObamaCare has revealed the painful consequences of placing our faith in big government. Government’s ambitions may be limitless, but its abilities are not. The free market, when allowed to function as intended, has no such limitations. It has an inexhaustible ability to empower our people and meet their needs.
America needs health care reform that will cut back government’s role and harness the forces of competition to keep health care prices low and spur innovation. That means not just repealing ObamaCare, but replacing it with a market-driven alternative and reforming Medicare and Medicaid for the 21st Century.
Marco is committed to the full repeal of the Affordable Care Act and to replacing it with consumer-centered health reforms that expand coverage and lower costs. Ending this failed law will be an urgent priority of his administration.
One of the first votes Marco took in the Senate was to repeal ObamaCare, and he has fought to replace the failed law ever since.
In addition to supporting the full repeal of ObamaCare, Marco has voted to specifically repeal harmful components of the law, including its devastating cuts to Medicare Advantage, the job-killing medical device tax, and restrictions on patient-centered care, including new taxes on FSAs and HSAs.
Marco was the first to warn of a taxpayer bailout of the insurance industry in ObamaCare, and introduced legislation to stop a bailout. His efforts recently saved taxpayers $2.5 billion.
Expand access to affordable, quality health coverage by providing every American with an advanceable, refundable tax credit that can be used to purchase insurance.
Reduce health care costs, promote innovation, and ensure access for the most vulnerable by expanding access to consumer-centered health plans, reforming insurance regulations, and putting protections in place to ensure those with pre-existing health conditions can get access to affordable coverage.
Promote innovation in the Medicaid program by giving states a per-capita block grant, which preserves funding for Medicaid’s unique populations while freeing states from Washington mandates.
Strongly defend traditional Medicare and Medicare Advantage for current seniors.
Strengthen Medicare for future seniors by providing them with choices between a variety of private plans and traditional, fee-for-service Medicare.
Place Medicare on a pathway to fiscal sustainability by promoting market competition in the program. This will ensure it is there for generations of seniors to come.
Bernie Sanders:
Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
As a patient, all you need to do is go to the doctor and show your insurance card. Bernie’s plan means no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges.
We outspend all other countries on the planet and our medical spending continues to grow faster than the rate of inflation. Creating a single, public insurance system will go a long way towards getting health care spending under control. The United States has thousands of different health insurance plans, all of which set different reimbursement rates across different networks for providers and procedures resulting in high administrative costs. Two patients with the same condition may get very different care depending on where they live, the health insurance they have and what their insurance covers. A patient may pay different amounts for the same prescription depending solely on where the prescription is filled. Health care providers and patients must navigate this complex and bewildering system wasting precious time and resources.
By moving to an integrated system, the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively. It will also ensure the federal government can track access to various providers and make smart investments to avoid provider shortages and ensure communities can access the providers they need.
Bernie’s plan will cost over $6 trillion less than the current health care system over the next ten years.
The United States currently spends $3 trillion on health care each year—nearly $10,000 per person. Reforming our health care system, simplifying our payment structure and incentivizing new ways to make sure patients are actually getting better health care will generate massive savings. This plan has been estimated to save the American people and businesses over $6 trillion over the next decade.
The typical middle class family would save over $5,000 under this plan.
Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.
Businesses would save over $9,400 a year in health care costs for the average employee.
The average annual cost to the employer for a worker with a family who makes $50,000 a year would go from $12,591 to just $3,100.
THE PLAN WOULD BE FULLY PAID FOR BY:
A 6.2 percent income-based health care premium paid by employers.
Revenue raised: $630 billion per year.
A 2.2 percent income-based premium paid by households.
Revenue raised: $210 billion per year.
This year, a family of four taking the standard deduction can have income up to $28,800 and not pay this tax under this plan.
A family of four making $50,000 a year taking the standard deduction would only pay $466 this year.
Progressive income tax rates.
Revenue raised: $110 billion a year.
Under this plan the marginal income tax rate would be:
37 percent on income between $250,000 and $500,000.
43 percent on income between $500,000 and $2 million.
48 percent on income between $2 million and $10 million. (In 2013, only 113,000 households, the top 0.08 percent of taxpayers, had income between $2 million and $10 million.)
52 percent on income above $10 million. (In 2013, only 13,000 households, just 0.01 percent of taxpayers, had income exceeding $10 million.)
Taxing capital gains and dividends the same as income from work.
Revenue raised: $92 billion per year.
Warren Buffett, the second wealthiest American in the country, has said that he pays a lower effective tax rate than his secretary. The reason is that he receives most of his income from capital gains and dividends, which are taxed at a much lower rate than income from work. This plan will end the special tax break for capital gains and dividends on household income above $250,000.
Limit tax deductions for rich.
Revenue raised: $15 billion per year
Under Bernie’s plan, households making over $250,000 would no longer be able to save more than 28 cents in taxes from every dollar in tax deductions. This limit would replace more complicated and less effective limits on tax breaks for the rich including the AMT, the personal exemption phase-out and the limit on itemized deductions.
The Responsible Estate Tax.
Revenue raised: $21 billion per year.
This provision would tax the estates of the wealthiest 0.3 percent (three-tenths of 1 percent) of Americans who inherit over $3.5 million at progressive rates and close loopholes in the estate tax.
Savings from health tax expenditures.
Revenue raised: $310 billion per year.
Several tax breaks that subsidize health care (health-related “tax expenditures”) would become obsolete and disappear under a single-payer health care system, saving $310 billion per year.
Most importantly, health care provided by employers is compensation that is not subject to payroll taxes or income taxes under current law. This is a significant tax break that would effectively disappear under this plan because all Americans would receive health care through the new single-payer program instead of employer-based health care.
Prescription Drugs.
- Require Medicare to use its bargaining power to negotiate with the prescription drug companies for better prices.
- Allow individuals, pharmacists, and wholesalers to import prescription drugs from licensed Canadian pharmacies.
- Prohibit the U.S. from agreeing to provisions in international trade deals that would raise drug prices in the United States or extend the monopoly period when a brand name drug company has no generic competition.
- Suspend the government’s authority to destroy packages of imported drugs at the border until new legislation is passed ensuring that Americans can import safe and affordable drugs from Canada.
- Close the Medicare Part D donut hole for brand and generic drugs by 2017.
- Require generic drug companies to pay an additional rebate to Medicaid if their drug prices rise faster than inflation.
- Restore Medicare prescription drug discounts for low-income seniors and people with disabilities.
- Prohibit anti-competitive deals – “pay-for-delay” deals – between brand and generic drug makers.
- Require pricing and cost transparency
- Require drug companies to publicly report information that affects drug pricing.
- Under the Sanders plan, drug makers would be required to report certain price information to the federal government and the public on their products, including the total expenditures on research and development and clinical trials, as well as the portion of their drug development expenses offset by tax credits or paid for by federal grants.
- Companies would also be required to report not only the price information charged to federal payers, such as Medicare, but would also have to submit price, profit, and sales information for other countries in which the drug is sold.
Donald Trump:
The current state of the Department of Veterans Affairs (VA) is absolutely unacceptable. Over 300,000 veterans died waiting for care. Corruption and incompetence were excused. Politicians in Washington have done too little too slowly to fix it. This situation can never happen again, and when Donald J. Trump is president, it will be fixed – fast.
The guiding principle of the Trump plan is ensuring veterans have convenient access to the best quality care. To further this principle, the Trump plan will decrease wait times, improve healthcare outcomes, and facilitate a seamless transition from service into civilian life.