By Kenneth D
Keeping up with the dizzying twists and turns of the 2016 primary season is enough to give any voter whiplash. Regardless of where you fall on the political spectrum, though, it is important to understand where the candidates stand on the issues that matter most, including health care. This issue affects every American, but any changes will have a significant impact on family caregivers, seniors and those nearing the retirement age.
Earlier this month, AgingCare.com conducted a survey asking caregivers about their candidate preference based on their plans for the American health care system. Of more than 1,500 caregivers, just over one-third (34%) of respondents favor Hillary Clinton’s proposed health care policies. Donald Trump trailed in second place (26%) and Bernie Sanders came through as a close third (24%).
At stake this presidential election are the future of the Affordable Care Act (also known as “Obamacare”), changes to Medicare and Social Security benefits, competing proposals for lowering the cost of prescription drugs, and the potential sale of health insurance across state lines.
The second component of AgingCare.com’s Health Care and the 2016 Presidential Election Survey required respondents to select three health-related concerns they believe should be top priorities for the next president. The list of issues included repealing the Affordable Care Act (ACA), continuing ACA, Medicare, Medicaid, Veterans care, prescription drug programs, the sale of health insurance across state lines, coverage for pre-existing medical conditions, Alzheimer’s disease, healthy living incentives, implementation of electronic medical records, and the rising costs of health care.
Over 42 percent of respondents feel that addressing the mounting costs of health care should be a top priority for the winner of the 2016 election, and just over 35 percent are concerned about the future of Medicare.
Furthermore, there is a considerable divide amongst caregivers regarding the fate of the Affordable Care Act. Just under one-third (32%) of participants feel that the ACA should be continued or improved, and 28% believe that the next president should focus on repealing the ACA altogether. Improving care for United States veterans (24%) and creating programs for more affordable prescription drugs (22%) are also important respondents.
Participants were able to write comments expanding upon their answers and reasoning, and an overwhelming number provided this additional insight. Many specified that universal or single-payer health care was a large concern and should have been included on the list of issues. Below are a few other comments made by survey respondents:
“Allow people to choose what they want in a healthcare plan. Don't force them to accept things they don't want or need. Allow young people to purchase low price plans that cover major injuries or illness only. Let people choose what plan is best for them, not the government.” –rnmom33
“Keep funding Medicaid programs. Many of our seniors are living in poverty—more than you would ever think. They are too proud to ask for assistance and are going without food or medicine to pay their bills. If those programs are cut, including Social Security, our nation will be in a humanitarian situation like we have not seen before. Also something should be done to regulate drug costs which are out of control for such things as diabetes.” –Unknown respondent
“There should be a focus on caregiving issues. We provide billions of dollars in unpaid care, yet caregiving is never mentioned by candidates. At least Bernie Sanders has a record of speaking on it, but Hillary Clinton is so fixated on the "youth vote" that she ignores us. I do not see any GOP candidate that cares about the elderly in a meaningful way, nor do I believe tax credits are helpful for anyone taking care of someone with dementia or other disabling illnesses.” –Cat
“We need free market competition if costs are to be contained. Too much regulation has resulted in higher costs and less individual choices in doctors, medications, treatments and quality of care.” –Unknown respondent
“As an oncology social worker, I can say Obamacare has saved lives. Prior to Obamacare, my young patients could not get insured. Cancer meant game over. Now they have a chance. We must keep Medicare, Medicaid and Obamacare, as these three programs are the main ways American citizens receive healthcare. To repeal or diminish any of these is another nail in the casket of the poor, and that is neither American nor Christian. We can do better.” –Unknown respondent
AgingCare.com has created a tool to assist family caregivers in making sense of these controversial topics. The following objective guide compares each candidate’s stance on key health care issues based on their statements to the press and in debates, as well as public information available on their campaign websites.
- ACA: Clinton supports the ACA. As president, she plans to strengthen this legislation by making it more affordable for families to purchase health insurance on the ACA exchanges. Her plan calls for a tax credit of up to $5,000 per family to offset a portion of excessive out-of-pocket and premium costs above five percent of their income. Clinton pledges to enhance premium tax credits so that those who are now eligible will pay less of a percentage of their income than under current law, and ensure that all families purchasing on the exchange will not spend more than 8.5 percent of their income on premiums. She supports preventing insurance companies from denying coverage to individuals with pre-existing conditions. Clinton opposes a single-payer health system.
- Medicare: Clinton opposes any plans to privatize or “phase out” Medicare as we know it by shifting seniors to private plans. She says she will work to lower Medicare costs while protecting quality with a “bundle” approach to treatment that pays for care as a whole, rather than traditional “fee for service” payments.
- Prescription drug prices: Clinton supports allowing Medicare to negotiate drug prices and also capping how much patients have to pay out-of-pocket for their drug costs. She also supports allowing Americans to import lower-cost drugs from foreign countries with approved safety standards and wants to require drug companies to invest profits in drug development and innovation, rather than consumer marketing.
- ACA: Senator Cruz opposes this statute and will work to repeal it. Instead, he proposes “commonsense reforms” that make health care personal, portable and affordable through expanded marketplace competition. Cruz supports allowing people to purchase health care coverage across state lines, expanding health savings accounts, and de-coupling health insurance from employment, so if individuals lose their job, they won’t lose their insurance. He has not addressed pre-existing conditions in his plans.
- Medicare: Cruz says he will protect Medicare for today’s seniors. For younger workers, he supports gradually increasing the retirement age/Medicare eligibility age and other alterations to protect Medicare “for decades going forward.” At the time of publication, Cruz has not announced additional reform details.
- Prescription drug prices: Cruz has proposed reducing federal regulations on pharmaceutical companies, which he says will decrease drug development costs and lower the cost of prescription drugs in the marketplace.
- ACA: Governor Kasich opposes the ACA. He says that, as president, he will work to repeal the law and replace it with a new, conservative approach based on his experiences as Governor of Ohio. Kasich's plan centers on two pillars intended to reduce costs: expanding affordable patient-centered primary care with an emphasis on preventative care and rewarding value rather than volume. Ohio’s largest commercial insurers and Medicare managed care plans are currently designing a system that shares these cost savings across the state. Kasich supports a similar plan across the country, and he says that the “Ohio Model” provides a path forward because it offers better patient-centered care, more choices and market competition, decentralized decision-making, and higher quality care.
- Medicare: Kasich says he supports “episode-based payments” that pay for the entire procedure as a whole rather than piecemeal. He says he supports nationwide entitlement reforms for Medicare that will lower the program’s cost while protecting care quality.
- Prescription drug costs: Kasich says he will promote competition by bringing generics to market more quickly, although at the time of publication he has not released any additional specifics.
- ACA: Senator Sanders would replace the ACA with a “Medicare-for-all” universal health care system that provides every American with access to affordable, quality care. Sanders calls extending healthcare to all, “A morally principled and financially responsible decision.” He says that his single-payer health care plan would eliminate co-pays, deductibles and fighting insurance companies for coverage approval. Sanders says that middle class families would save over $5,000 annually on health care with his plan, which would be funded by: an employer health premium, an income-based household premium, progressive income tax rates, a change in capital gains and dividends tax rates, limiting deductions for the rich, a change to the estate tax, and savings from health tax expenditures.
- Medicare: Under Sanders’ universal health care proposal, all Americans would have access to an expanded Medicare plan, including seniors. Sanders says that he will restore discounts to seniors under Medicare Part D and that he will work to close the Medicare donut hole in 2017, three years earlier than the current schedule.
- Prescription drug prices: Sanders supports allowing Americans to purchase drugs from other industrialized countries, including Canada, which he estimates will result in cost savings up to 40 percent. He also supports allowing the government to negotiate with pharmaceutical companies for lower Medicare prescription prices.
- ACA: Trump strongly opposes the Affordable Care Act and says that his first goal in office will be to repeal it. Next, Trump says he will call on Congress to modify the law prohibiting the sale of health insurance across state lines. He supports allowing all individuals to fully deduct health insurance premium payments on their tax returns. Trump also supports allowing all individuals to use Health Savings Accounts (HSAs). He supports “price transparency” for all doctors and medical providers so that patients can compare providers to find the best prices for procedures and exams. Trump does not address pre-existing conditions in his reform plan.
- Medicare: Trump pledges to lower Medicare costs by allowing the government to negotiate with prescription drug companies (see below). He opposes cuts to Medicare and has not announced additional reform plans for Medicare at this time.
- Prescription drug prices: Trump blames drug companies for keeping costs high and supports allowing Medicare to negotiate for drug prices, which he says will result in $300 billion in savings. He also says he will remove the barriers to entry into free markets so drug providers can offer safe products at a cheaper price. Trump supports consumers’ access to safe and dependable drugs imported from overseas.
While each candidate and American citizen may differ in their opinions of what would be best for this country’s health care system, it is undeniable that something must change. Chronic illnesses, progressive conditions like Alzheimer’s and Parkinson’s, caregiving, and health care costs affect entire families, often over multiple generations. These hardships will only become more prevalent and troublesome as our nation continues to age. Be sure to stay informed and act in support of those measures you believe to be most beneficial to your loved ones and your country.