On the Issues: Candidates’ band-aid solutions seek to cut health spending
Health care is the policy area where both the parties and individual candidates are farthest apart. Democrats tend to favor federal health insurance. Republicans think this is unnecessary spending that drives up costs of health products. While Republicans are already furious about Obamacare — an act nicknamed after President Barack Obama that allowed states to expand Medicaid access if they pleased. Republicans want to remove the restriction on selling health insurance across state lines, while Democrats think that incentivizes states to deregulate health care until it’s completely worthless in order to encourage health insurance companies to headquarter themselves in their states.
Inside the parties, it has become one of the only topics at the forefront for both Democrats and Republicans.
Senator Ted Cruz (R–TX)
Cruz vehemently wants to “repeal and replace” Obamacare. He often makes sure people know he won’t forget parts and will repeal every single word of the health care law. His replacement plan has three points.
Cruz’s first point is to allow health insurers to sell across state lines to create a nationally competitive market. In theory, this will drive down costs, especially in sparsely populated states, as state health insurers have more competition.
His second point is to expand the use of health savings accounts, which is sort of like a tax-free bank account that people with high deductible plans can use. These accounts contain pre-tax income that someone can use to spend on health care only. It is something like a tax credit for having a high-deductible plan.
His third point is to delink health insurance from employers. This should have three benefits. One, it opens up many more options to people buying health insurance since they are not restricted to their employer’s options. Two, it drives up wages because companies do not have to pay for health care benefits. Three, it allows people to move jobs more freely and makes the labor market more dynamic and efficient.
Ohio Governor John Kasich
Kasich was one of the only Republican governors to expand Medicaid access in his state in accordance with Obamacare. Kasich also calls access to affordable health insurance a high priority. However, he feels Obamacare did not solve the problem of Americans paying fees for health services, which creates an incentive to provide care but not necessarily effective care.
Kasich has moved Ohio towards episode-based health care payments. This is credited with some reduction of health care costs in Ohio. It is a similar idea to many provisions in Obamacare, which attempt to base incentives on results instead of on what is provided. Kasich believes his model in Ohio would be an improvement on the current system created in Obamacare. He also wants to improve primary care by expanding access to primary care physicians and making regular doctor’s visits a key aspect of health care plans. He believes this cuts the most costs because it makes it less likely that people will need to cover major expenses for catastrophic injuries and illnesses in the future.
Steak tycoon Donald Trump
Like many Republicans, the first bullet point in [Trump's health care plan](https://www.donaldjtrump.com/positions/healthcare-reform is to repeal Obamacare, particularly the individual mandate.Marching right along with conservative orthodoxy, his second bullet point is allowing Americans to buy health insurance across state lines.
Many observers are calling Trump’s proposal quintessentially Republican. He wants to bring free market reforms to health care by increasing price transparency from healthcare providers, thereby enabling price comparisons by consumers and lowering the barriers for drug providers to begin marketing drugs in the U.S.
His tactics to cover low income Americans are also standard conservative fare. He would like to trade out Obamacare's tax subsidies with tax deductions for an individual’s health insurance premium payments, and shift Medicaid power toward the states by giving them block grants. It would be up to the state to decide what services to fund.
Finally, Trump wants to expand the use of health savings accounts similar to Cruz. Combined with the tax credits Trump has proposed for deductibles, this would mean the vast majority of Americans would end up with no income tax liability were Trump to take office.
Above all, though, Trump claims he will grow the economy so that people will have jobs and make sufficient income to pay for their health insurance without government help.
Former Secretary of State Hillary Clinton
This is not Clinton’s first rodeo when it comes to health care on a national scale. Clinton had a major influence on her husband Bill Clinton’s health care remodel in 1993. Harkening back to those days, Clinton continues to battle insurance and drug companies, saying she would want “authority to block or modify unreasonable health insurance rate increases” and hold drug companies accountable.
Clinton has aligned herself with Obama on healthcare, promising to protect and build on the base of Obamacare. She is seeking to expand the Obamacare exchanges to include illegal immigrant families, and wants to cap the patient's share of doctor bills and prescription drug costs. She has also been at odds with Obama about a tax on high-cost, employer-sponsored insurance, which she would like to repeal. She is also seeking tax credits, up to $2,500 a year for an individual and $5,000 for a family, if out-of-pocket health costs exceed 5 percent of income. Many of these changes are designed to lower patient copays and deductibles, a key running point for Clinton.
She has also made women’s reproductive rights and access to abortion a fundamental part of her campaign, and intends to support Planned Parenthood and combat restrictions on abortion such as the Hyde Amendment.
Senator Bernie Sanders (I–VT)
Sanders is proposing a complete overhaul of the American health care system in the fashion of the universal health care plans found in Europe and Canada. It would be a single-payer system, meaning a government agency would run the financing side of health care, but treatment and delivery would remain mainly in the private sector with the same doctors and hospital systems. People seeking treatment would simply go to the doctor, show their insurance card, and receive treatment without any copays or deductibles.
Sanders’ plan would nationalize the health insurance industry, but health service providers would still be considered a private industry.
Instead of private insurance charges, Sanders proposes raising the money through increased taxes and spending cuts. He will increase the employer portion of the payroll tax by 6.2 percent, impose a 2.2 percent income tax paid per household, and start a bevy of taxes on the rich, including increased income tax and more comprehensive capital gains and estate taxes. He also hopes to cut national healthcare spending by $400 billion.
In addition to these big structural changes, Sanders is also focusing on improving mental health care access in the U.S, particularly for veterans, and maintaining food stamp and nutrition programs. These costs prevent people from having to come in for more expensive emergency care later in the proccess. He and Clinton agree on holding drug companies accountable for keeping drug prices low.