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Monday, February 15, 2016

Where the Candidates Stand on Healthcare Issues


MEDSCAPE -- Julie Edgar February 01, 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 (the Affordable Care Act, or "Obamacare"), Medicare and Medicaid, the price of prescription drugs, and abortion. Candidates included are those who received 5% or higher in the Jan. 12 New York Times/CBS News national poll.

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

Jeb Bush

Obamacare:

· Repeal it. Offer a tax break for workers on health benefits they receive through their employer.

· Allow small businesses to make tax-free contributions toward their employees’ health plans.

· Encourage states to guarantee coverage for people with preexisting conditions, and make affordable health plans available.

Health care costs:

· Provide a tax credit for catastrophic insurance plans.

· Increase contribution limits for health savings accounts from $3,350 to $6,550.

· Cap the employer tax exclusion. This means employer-provided plans that cost more than $12,000 for individuals or $30,000 for families would be taxed. (There is currently no limit on employer contributions for premiums, but the Affordable Care Act calls for a “Cadillac” tax beginning in 2020 on plans costing more than $10,500 for individuals and $27,500 for families.)

Drug Prices: No information available.

Medicare:

· Privatize it -- allow seniors to keep their health savings accounts and choose from various private health plans each year, along with traditional Medicare.

· Lower government subsidies for wealthier people.

Medicaid:

Bush has not said clearly what he would do as president. As Florida’s governor, he privatized Medicaid, allowing insurers to decide what to offer and giving consumers more choices. The program has since been scrapped.

Abortion:

Bush defunded Planned Parenthood in Florida as that state’s governor. He would do the same to the national organization. He believes abortion should be restricted to cases of rape and incest and when the mother’s life is at risk.

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.

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.

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.

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.

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.

http://www.medscape.com/viewarticle/858099

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