The Healthcare System in the United States of America: the 2016 Presidential Candidates’ Healthcare Plans – PART 3/3

On October 8th later this year, the 58th presidential elections will be held. This final article in a series of three will have a look at the different propositions and ideas voiced by the current leading candidates regarding their approaches and management plans for the US healthcare system during their presidential term. The highlights of their healthcare plans mentioned below are purely derived from their own statements and official public webpages.

The current candidates still in the running for the Republican Party are US Senator Ted Cruz (Texas), Governor John Kasich (Ohio), and Businessman Donald Trump (New York); the candidates still in the running for the Democratic Party are former US Secretary of State Hillary Clinton (New York) and US Senator Bernie Sanders (Vermont).

The general consensus amongst the candidate’s plans are to build on Medicaid and allow cross-border insurance purchases/plans. The repeated catch phrases are to boost competition, contain and reduce costs, provide universal coverage, and repeal (most of) Obamacare.

The United States has a GDP of €14,840 bn, with a GDP growth rate of 2.4% in 2015. Over the last 5 years it has spent an average of €7,600 per capita on public healthcare, equivalent to approximately 17% of its annual GDP.

Despite being one of the highest spenders on healthcare in the world, the USA repeatedly ranks on the lower end when comparing (developed) healthcare systems across the globe.

The current healthcare system

The Patient Care and Affordable Care Act (PPACA), aka the Affordable Care Act (ACA) or Obamacare, introduced in 2010 shapes the current US healthcare system. It seeks to provide universal healthcare, maintain low member contributions, and regulate the insurance funds to avoid patient skimming. Complimentary to this, runs an updated version of the previously existent Medicare (for seniors) and Medicaid (for the most vulnerable). Currently around 90% of the US population is covered by the ACA.

Republican candidates

US Senator Ted Cruz (Texas)

  • Wishes to repeal Obamacare completely.
  • Wishes to defund, repeal, and replace federal care with a free market/market-based healthcare system, intent on making healthcare more affordable.
  • Expand Health Savings Accounts*, enabling individuals to purchase insurance across state borders and make healthcare cheaper and more flexible
    • *Health Savings Accounts (HSA) are exempt from federal income tax, representing the saving accounts of high-deductible healthcare plan members, where the funds are accumulated when not spent
  • Introduced the Reciprocity Ensures Streamlined Use of Lifesaving Treatments Act (RESULT Act), which proposes reciprocity between the USA and “trusted” trading partner countries when approving drugs. It would speed up FDA reviews of medication and medical devices that are already approved and marketed in other developed and accountable countries. It aims to speed up the access to life-saving medication.
  • Supports reforms that seek to make the FDA a more cooperative party with academics and medical professionals in the USA, for the research and development of curative treatments and disease prevention.
  • Supports initiatives to guarantee high conformity of medical standards and quality in abortion clinics.

Governor John Kasich (Ohio)

  • Refers to his approach as the Ohio model, which entails “patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals and an end to Obamacare’s big government interference”.
  • Supports the repeal of Obamacare, and wishes to replace it with a system that enables personal healthcare choices for Americans, and avoids burdening employers.
  • Believes that Medicaid and insurance market regulation is not a one-size-fits-all, and that control should be relinquished to the states to maximize regional efficiency and solutions.
  • Wishes to avoid fee-for-service compensation schemes that can lead to over-provisions and unnecessary/inefficient services.
    • Plans to reward value instead of volume and create episode-based payment mechanisms that will push the providers to seek the most cost-efficient and outcome effective care paths.
    • Particularly high-cost therapies and episodes are in the spotlight.
  • Plans to improve primary care, i.e. patient-centered primary care, making it a pre-emptive and long-term driven service rather than a reactionary function.
  • Believes in sharing the savings (made through enhancement measures) with the providers who can deliver improved outcomes and who reduce overall expenditure.
  • Believes in increasing home-based care in lieu of nursing home care.
  • Has worked on expanding social program funding and mental illness care during his career in Ohio.

Businessman Donald Trump (New York)

  • Plans a full repeal of Obamacare.
    • No statutory healthcare insurance membership.
  • Believes in free market reforms for the healthcare industry, economic freedom, and strongly committing Congress to implement changes.
    • Wishes to remove market barriers for drug providers, facilitating the trade of (safe and dependable) drugs from overseas.
    • Believes in competition between insurance providers to boost quality and contain costs.
  • Believes individuals should be able to deduct insurance premiums from their tax returns under the existing taxation.
  • Wants to keep core aspects of the current Social Security, Medicaid and Medicare, which will be made possible when “America (has been made) Great again” and wealthier accordingly.
    • Perform reviews of the basic options for Medicaid to ensure coverage for those who want it.
  • Promotes the use of HSAs for individuals and that these are transferable to heirs without a penalty.
  • Plans to boost price transparency from healthcare providers.
  • Believes in block-grants for Medicaid for the states.
  • Plans to enforce immigration laws to ease the burden on social health and welfare budgets.
  • Believes the best social program consists of employment and boosting the economy as a whole to create opportunities and means to strengthen healthcare.

Democratic candidates

Former US Secretary of State Hillary Clinton (New York)

  • Plans to defend the ACA Act and enhance it to slow down the incremental growth of out-of-pocket payments.
    • Aims to lower the costs of ACA exchanges*
      • *Health Insurance exchanges are available from the public and private sector and are represented in 4 different categories of insurance packages (offering different out-of-pocket to premium contribution ratios), to be selected from an online market place. It is subsidized for qualifying individuals and a popular alternative for small business employers.
    • Wishes to ensure that all families purchasing exchanges do not spend more than 8.5% of their incomes on premiums.
  • Wishes to contain prescription drug prices and push drug manufacturers to be accountable and invest into research.
  • Supports women’s reproductive health freedoms, including abortion rights and contraception.
  • Plans to match any state’s Medicaid expansion by 100% during the first 3 years, along with other incentives, to meet healthcare needs of the most vulnerable.
  • Plans to invest for an active enrollment campaign for the entitled uninsured (into Medicaid).
  • Believes that families, regardless of immigration status, should be able to purchase health exchange insurance.
  • Supports a public option insurance scheme, i.e. an alternative government-run insurance, able to compete with the private sector insurances, in order to widen the selection for the public and contain costs.
  • Wishes to reward the healthcare providers when delivering quality and value.
  • Plans to improve rural healthcare.

US Senator Bernie Sanders (Vermont)

  • Plans to build on the existing successes of the ACA with a strong aim at achieving universal coverage.
  • Plans to create a single-payer healthcare system administered by the federal government.
  • Reduce administrative costs caused by the overload of different public insurance providers.
    • Streamline care tracks and simplify the care system
  • Wishes to introduce an insurance card for all patients, to eliminate all unnecessary complexities, fine print, deductibles, worries over whether or not a provider is included in a particular care network, and disagreements with insurance providers over reimbursement claims.
  • Proposes an integrated system where the government has leverage to negotiate fair prices with pharmaceutical companies, to increase access and to make intelligent investment choices.
  • Plans to pay for the system as follows:
    • 2% income-based healthcare premiums paid by employers
    • 2% income-based premiums paid by households
    • Progressive income tax rates
    • Taxing capital gains and dividends the same way as work-related incomes
    • Limit tax deductions for the rich (referring to households earning over $250,000/year)
    • Taxing estates of the wealthiest 0.3% of Americans
    • Recuperating savings from obsolete subsidies
  • Plans to invest in training healthcare providers to create a sustainable healthcare workforce.

It will be interesting to see who wins the election, which promised plans will be implemented, how they will be financed, and what health outcomes they will provide.

About Laura Weynants

Performs primary and secondary market research to create country reports at TforG. Interviews KOLs and medical sector professionals to build on TforG’s healthcare market expertise and competence networks. Complementing five years of sustainability policy and CSR communication, she now focuses on grasping key medical market trends, structures and opportunities in medical sectors worldwide. Coming from an international background of living in Germany, Spain, USA, UK and Belgium, she has gained a keen insight in international organizations and language skills to perform first hand investigations. She graduated from Sussex University Brighton, UK with a BA English Literature and Sociology and achieved a Master Degree in Sustainability and Corporate Social Responsibility in EOI Business School in Madrid, Spain.