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Tuesday Oct 11, 2016

Donald or Hillary? How Choice Affects Health Care

In less than 30 days, the United States will elect its 45th president. The upcoming elections also will determine who represents your state and community in the U.S. House of Representative and Senate -- not to mention thousands of state and local offices.  

Nov. 8 will bring to a close one of the more memorable presidential campaigns in modern history. If you watch television or read a newspaper you have likely heard that this is the "most important election of our lifetime." Pundits and political operatives tend to say this every four years, so the idea has a bit of a "boy who cried wolf" feel to it. I find such statements a little amusing.  

Electing a single individual to lead the most economically and militarily powerful country on earth is a process that should be taken seriously, by each of us, every time. To this end, whether you are "with her," want to "make America great again," or even if you can't stand either of the major parties' candidates,  I urge you to participate in our electoral process and cast your ballot on Nov. 8 or through your state's early voting opportunities. To quote the incomparable Winston Churchill, "Democracy is the worst form of government, except for all the others."

Our next president will be responsible for overseeing the federal government for the next four years, including major health insurance programs such as Medicare, Medicaid, and the Veterans Health Administration. To date, the two leading candidates have not featured health care as priority issues for their campaigns. I will note that a former President has made some headlines for his views on health care lately, but the two candidates themselves have stayed focused on other issues -- mainly each other.  

While health care hasn't emerged as a top-tier issue for the campaigns in the 2016 elections, the economics of health care continues to be important to voters. The September Kaiser Health Tracking Poll(kff.org) includes some interesting insights into voters attitudes towards health care coverage and cost. Sixty percent of respondents said the cost of health insurance premiums is "very important" to their vote for president in 2016.  Additionally, 55 percent stated that the cost of health insurance deductibles is "very important" to their vote for president in 2016. Fifty-one percent said that the cost of prescription drugs is "very important" to their vote.

Despite a daily focus on large-scale health care reforms, both candidates have expressed their commitment to addressing the opioid epidemic and their support for greater access to mental health services. The campaigns also have expressed a desire to improve access to care for our nation's veterans. Another interesting area where the candidates have expressed shared concern is the cost of prescription drugs. Interest in this area makes good political sense - it's a kitchen table issue for millions of Americans who are facing escalating bills due to the cost of their prescription drugs. The Kaiser Health Poll mentioned above showed that 77 percent of Americans view the cost of prescription drugs as "unreasonable." More than 35 percent of individuals who take four or more drugs state that it is difficult for them to afford their prescription drugs.

The health policy agenda of the two candidates are difficult to compare due to a lack of comprehensive proposals on the part of the Trump campaign. Kaiser Family Foundation has a side-by-side comparison of the candidates' positions on seven key health care issues(kff.org). I have found this to be the most comprehensive resource other than the candidates' websites. The following are the top-line policies each candidate is advancing as their "health care agenda."

Donald Trump's health care agenda(www.donaldjtrump.com) is outlined in a five-point plan:

  • Repeal and replace the Patient Protection and Affordable Care Act with health savings accounts.
  • Work with Congress to create a patient-centered health care system that promotes choice, quality and affordability.
  • Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage. 
  • Allow people to purchase insurance across state lines, in all 50 states, creating a dynamic market.
  • Maximize flexibility for states via block grants so that local leaders can design innovative Medicaid programs that will more appropriately serve their low-income citizens.

Hillary Clinton has published several position papers(www.hillaryclinton.com) on a variety of health care issues. In addition, she has a nine-point health care plan(www.hillaryclinton.com):

  • Defend and expand the Affordable Care Act, which covers 20 million people.
  • Bring down out-of-pocket costs like copays and deductibles.
  • Reduce the cost of prescription drugs.
  • Protect consumers from unjustified prescription drug price increases from companies that market long-standing, life-saving treatments and face little or no competition.
  • Fight for health insurance for the lowest-income Americans in every state by incentivizing states to expand Medicaid.
  • Expand access to affordable health care to families regardless of immigration status.
  • Expand access to rural Americans, who often have difficulty finding quality, affordable health care.
  • Defend access to reproductive health care.
  • Double funding for community health centers, and support the health care workforce.

The most notable difference is the respective positions on the Affordable Care Act. Secretary Clinton supports the law but seeks to improve it. Trump opposes the ACA and pledges to repeal it. The two also split on Medicaid. Trump is promoting the well-established Republican policy of providing states block-grants to operate their Medicaid program. Clinton would expand access to the traditional federal-state partnership model for the Medicaid program.

Regardless of the outcome on Nov. 8, the AAFP will be prepared and positioned to advance policies aimed at improving our health care system for you and your patients.  We also will provide information and insight through this blog and AAFP News.

 Go vote!

Posted at 07:00AM Oct 11, 2016 by Shawn Martin

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ABOUT THE AUTHOR



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.