Where the Candidates Stand on Health Care Issues

From the WebMD Archives

Jan. 29, 2016 -- Although terrorism and the economy have topped Americans’ list of concerns in recent polls, health care is still on voters’ minds.

WebMD looked at where presidential hopefuls from both parties stand on various health care issues, including the health care reform law (called the Affordable Care Act, or "Obamacare"), Medicare and Medicaid, the price of prescription drugs, and abortion. Candidates included are those who have finished in the top 5 of any of the early primaries and are still in the race.

Here’s what they said off and on the podium on these topics. If the candidate has not spoken about a topic or offered information on his or her web site, it will say “No information available.”

The Republican Candidates

Ben Carson

Obamacare:

  • Repeal it, and replace it with “health empowerment accounts” (HEAs), which will be opened for every citizen when they get their social security number. Individuals can contribute to their HEA tax free and use the money to pay for health care costs for themselves or a family member. Unused contributions remain in the HEA from year to year and transfer across state lines and throughout changes in employment.

Drug prices: No information available.

Health care costs: The health empowerment accounts will be paired with a high-deductible health plan to cover catastrophic medical expenses.

Medicare:

  • Require all people who use this program ("beneficiaries") to choose a private Medicare insurance plan using a fixed contribution. If a beneficiary chooses a plan that costs less than the government contribution, the remainder would go into their HEA. If the plan costs more than the federal contribution, the beneficiary could use HEA to pay the remainder of the premium.
  • Gradually raise the eligibility age from 65 to 70.
  • Medicare beneficiaries would be able to use their HEAs to pay for out-of-pocket expenses, deductibles, and copayments.

Medicaid:

  • Give all Medicaid beneficiaries the option of enrolling in a private insurance plan.
  • Give states “fixed-dollar support,” also known as block grants, to pay premiums for the private plan.
  • Give enrollees “seed money” in their HEAs to cover out-of-pocket medical expenses like deductibles and copayments.

Continued

Abortion: Carson says it should be illegal in all cases -- even if a pregnancy is the result of rape or incest. But he's open to considering abortion when the health and life of the mother is at risk.

Sen. Ted Cruz (R-Texas)

Cruz does not have an official health care proposal on his campaign web site, so the following is based on proposals he introduced while in the Senate or on information gathered through published interviews.

Obamacare: Repeal it and expand health savings accounts, which allow individuals to contribute money tax-free and pay for medical expenses not covered by insurance. Allow individuals to purchase health insurance in any state, no matter where they live.

Drug prices: No information available.

Health care costs: No information available.

Medicare: Raise eligibility age from 65 and move to a premium-support system where beneficiaries are given a fixed amount of money to buy a Medicare insurance plan. If the plan chosen costs more than the government contribution, individuals would pay the difference.

Medicaid: Cruz opposes Medicaid expansion under Obamacare, saying it leaves states on the hook for major health care costs.

Abortion: He opposes it, including in cases of rape and incest. He supports bans on taxpayer-funded abortion and late-term abortions. He has vowed to defund Planned Parenthood should he win the presidency.

Gov. John Kasich (R-Ohio)

Obamacare: Repeal.

Drug prices: Kasich says the government should review drug industry pricing, given that taxpayer dollars go toward research and development.

Health care costs: The governor proposes a national version of an Ohio initiative in which the fee-for-service system is transitioned to one using patient-centered medical homes (PCMH) and episode-based payments. A PCMH is different from the typical arrangement in which a patient works with a doctor and pays for each medical service. It's a team-based method of coordinating care in which your doctor and a group of professionals (like nurses, pharmacists, and social workings) work together to treat you and answer questions. Health care providers who participate, meet quality standards, and contain costs will share in the cost savings. Ohio is using its Medicaid program to test the the model.

Continued

Medicare: Improve care coordination through Medicare Advantage, the Medicare program that covers Parts A and B and prescription drug benefits. Also reform payment practices “to increase value and quality” in order to hold spending growth to 5.3% annually.

Medicaid: To rein in costs, Kasich proposes  greater state flexibility. Funds would be allocated to states on a per-member, per-month basis by eligibility category, allowing states greater flexibility on rate setting and benefit design. Would hold spending growth to 3% annually. As governor, he expanded Medicaid under the Affordable Care Act, despite opposition from the state legislature.

Abortion: Kasich opposes it except in cases of rape, incest, or where the life of the mother is at risk. As a congressman, he voted to ban late-term abortions and opposed federal funding for abortions. As governor, he supported a ban on late-term abortions and a ban of elective abortions in public hospitals. Kasich also ended state funding of Planned Parenthood.

Sen. Marco Rubio (R-Florida)

Obamacare:

  • Repeal it, and replace it with a refundable tax credit to purchase health insurance that would increase each year.
  • Offer federal support for state-based “actuarially-sound” high-risk pools for people who have preexisting health conditions. (Currently most state high-risk pools take in less in premiums than they pay out in claims).
  • Allow individuals to buy insurance in any state, no matter where they live.
  • Expand health savings accounts to pay for medical expenses not covered by insurance. It would reduce the tax exemption for employer-provided insurance gradually so it eventually equaled the value of the refundable tax credit.

Drug prices: Speed FDA approval for less-expensive generic meds so they become available sooner and offer alternatives to certain medications.

Health care costs: Reform insurance regulations to “lower costs, encourage innovation, and protect the vulnerable.”

Medicare: Preserve traditional Medicare for current beneficiaries but transition future generations into a premium-support system, where the federal government provides a fixed contribution to beneficiaries to choose a private Medicare plan. If the chosen plan costs more than the government contribution, individuals must pay the difference.

Medicaid: Move the program into a state block-grant system based on population, allowing states to run the program without federal oversight.

Continued

Abortion:

  • Rubio opposes late-term (20 weeks or more) abortion.
  • He opposes taxpayer funding for abortion overseas, and pledges to defund Planned Parenthood and appoint Supreme Court candidates who oppose abortion.
  • He has not taken a clear position on exceptions in the case of rape or incest or when the mother’s life is at risk, but has supported legislation in the past with these exceptions.

Donald Trump

Trump does not have an official health care proposal on his campaign web site, so the following is based on information gathered through published interviews.

Obamacare: Repeal it. Allow consumers to buy plans from insurers in any state, no matter where they live. Trump supports the use of health savings accounts to pay for medical expenses not covered by insurance.

Drug prices: No information available.

Health care costs: No information available.

Medicare: Preserve Medicare by growing the economy to strengthen the program, but there's no detailed information available.

Medicaid: Trump says the government must provide assistance to those in need. No detailed information is available, but he says the government will work out a deal with hospitals to provide care for low-income people.

Abortion: He thinks it should be banned at some point in the pregnancy, but he supports abortion in the case of rape or incest or when the mother’s life is at risk.

The Democratic Candidates

Hillary Clinton

Obamacare: Clinton supports it.

Drug prices:

  • Require health insurers to cap out-of-pocket drug spending at $250 per month.
  • Fully fund the FDA's Office of Generic Drugs to speed generic drug approvals. And reduce the exclusivity period for biologic drugs from 12 to 7 years -- that's the amount of time brand-name biologic drug makers can't have competition.
  • Allow Americans to import meds for personal use from countries with safety standards equivalent to the U.S.
  • Eliminate corporate write-offs (tax benefits) for direct-to-consumer drug advertising.
  • Require FDA clearance for drug ads.

Health care costs:

  • Lower out-of-pocket costs like deductibles and copays.
  • Require all plans, including employer-provided plans, to provide individuals three sick visits per year without needing to meet the deductible first.
  • Provide a refundable tax credit of up to $2,500 for individuals and $5,000 for families if out-of-pocket costs are more than 5% of income (not available for Medicare beneficiaries or individuals who claim existing deductions for medical expenses).
  • Increase price transparency so people understand how much their health care costs.
  • Enforce anti-trust laws to investigate mergers and consolidations of providers and insurers. Strengthen state authority to block excessive insurer rate increases.

Continued

Medicare:

  • Oppose any plan to privatize Medicare.
  • Negotiate drug prices directly with drug companies to get better deals for Medicare beneficiaries -- currently, the federal government is prohibited from negotiating on drug prices.
  • Require drug makers to provide rebates to low-income Medicare enrollees equal to those offered under the Medicaid program.
  • Move away from a fee-for-service payment toward bundled payment in order to reduce doctors' incentive to order more tests and procedures.

Medicaid: Clinton supports state expansion of Medicaid under Obamacare. She supports a move away from fee-for-service payment toward bundled payment.

Abortion: Clinton is pro-choice.

Sen. Bernie Sanders (D-Vermont)

Obamacare: Sanders is in favor of a “Medicare-for-all” single-payer system that would provide all Americans with comprehensive health services. Private health insurance could only exist to provide supplemental coverage.

Drug prices:

  • Sanders would require the federal government to negotiate drug prices for Medicare.
  • Require generic drug makers to pay a rebate to Medicaid if their prices increase greater than the rate of inflation.
  • Restore Medicare prescription drug discounts for low-income seniors.
  • Prohibit brand-name drug companies from paying generic drug makers from delaying generic drugs from coming to the market.
  • Allow consumers, pharmacies, and wholesalers to import drugs from licensed Canadian pharmacies.
  • Require drug companies to disclose the prices they charge for their products overseas.

Health care costs: As under Medicare, the federal government sets a fee schedule for all providers.

Medicare: Expand the program to insure every American under a single-payer system. Close the Medicare prescription drug coverage gap (also known as the “donut hole”) by 2017, 3 years earlier than current law.

Medicaid: Until a universal health care plan is passed, expand and improve the program for low-income families.

Abortion:

  • Sanders is pro-choice.
  • Increase funding for Planned Parenthood, the Title X family planning program, access to birth control, and ensure the availability of safe and legal abortions.
WebMD Health News Reviewed by Michael W. Smith, MD on January 25, 2016

Sources

SOURCES:

CBS News/New York Times Poll, Dec. 4-8, 2015.

New York Times/CBS News Poll, Jan. 7-10, 2016.

Gallup poll, Dec. 14, 2015.

Washington Post: “5th Republican debate transcript, annotated: Who said what and what it meant,” Dec. 15, 2015.

The Guardian: “Democratic debate: after Sanders' apology, candidates spar on Isis, taxes and guns - as it happened,” Dec. 19, 2015.

ABC News/Washington Post Poll, Nov. 16-19, 2015.

Fox News Sunday: 2015 Coverage of 2016 presidential hopefuls, Sep. 27, 2015.

Meet the Press 2015 interview moderated by Chuck Todd , Nov. 1, 2015.

BenCarson.com.

Meet the Press, Oct. 26, 2015.

Cruz.senate.gov.

Republicanviews.org.

PBS NewsHour, Mar. 23, 2015.

MarcoRubio.com.

Youtube.com.

Face the Nation, Jan. 12, 2014.

Meet the Press, Aug. 9, 2015.

CNN: Dana Bash interview with Donald Trump, July 29, 2015.

PBS News Hour: "2016 Candidate Stands," June 16, 2015.

Hillary.com.

CBS News, Sept. 22, 2015.

Miami Herald: “In Broward, Hillary Clinton takes aim at Florida Republicans over climate change, Medicaid expansion,” Oct. 2, 2015.

Sanders.senate.gov.

govtrack.us: “Prescription Drug Affordability Act.”

BernieSanders.com.

FeeltheBern.org.

JohnKasich.com

On the Issues.

Fox Business Network.

Ohio Governor’s Office of Health Transformation.

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