[This post is part of a series looking at the health plans of the presidential candidates. You can read about Bernie Sanders’ health plan here, and Hillary Clinton’s plan here and here.]
Honestly, we’re not sure what to do with Donald Trump’s health plan. On the one hand, he is the leading Republican candidate for president, and he does have an actual plan up on his website that’s about as detailed as anything Marco Rubio or John Kasich (the GOP’s “serious” candidates) have put forward.
On the other hand, Trump seems to be making up his policy positions as he goes, so who knows what the plan will look like tomorrow. Health care experts have questioned how much effort, if any, he put into it, since he doesn’t appear to have a single health policy adviser, with some of the harshest criticism coming from conservatives. For example, Michael Cannon, director of health policy studies at the libertarian Cato Institute writes:
This isn’t a health reform plan. It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever. He doesn’t have a plan. He has paroxysms.
Yet for all the complaints from conservative health experts, what’s most striking about Trump’s plan/paroxysms is how similar it is to other Republican candidates’. This is a guy who told 60 Minutes, “Everybody’s got to be covered. This is an un-Republican thing for me to say… I am going to take care of everybody.” But his actual plan simply repeals Obamacare– leaving tens of millions more Americans uninsured– replacing it with almost nothing. [click to continue…]
In our look at Hillary Clinton’s health plan yesterday, we pointed out that of seven big problems that Obamacare didn’t fix, she had ignored perhaps the biggest. Despite saying that she shared Bernie Sanders’ goal of universal coverage, she hadn’t actually proposed a plan to get there. At the end of the post we said that we hoped she’d put out something more ambitious.
Well that didn’t take long. Less than hour after the post went up, we discovered that within the past day or two, Clinton has added a bunch more proposals to her campaign website, all with an eye toward expanding coverage to more of the uninsured. (For comparison, here’s what the healthcare section of her site looked like a week ago.) In addition to the things we mentioned in our last post, Clinton now says she would:
- Enhance the premium tax credits on the ACA’s exchanges;
- Fix the law’s “family glitch”;
- Support new incentives to encourage all states to expand Medicaid;
- Invest in navigators, advertising and other outreach activities to make enrollment easier;
- Expand access to affordable health care to families regardless of immigration status; and
- Continue to support a “public option”.
These new proposals would in fact expand coverage to more people, moving us closer to universal coverage. But how close would they actually get us? [click to continue…]
[This is the second post in a series on the health plans of the 2016 presidential candidates. Part 1, which looked at Bernie Sanders’ health plan, is here.]
Here’s what the 2016 Democratic candidates for president agree on: They agree that healthcare in America is better since the Affordable Care Act. They also agree that there are still problems that need to be fixed, and they mostly agree on what those problems are– a list that looks pretty similar to one we made a while back:
- We still don’t have universal coverage;
- Unaffordable out-of-pocket costs;
- Buying and using insurance is incredibly confusing;
- Narrow provider networks;
- Price-gouging by providers;
- Lack of dental coverage; and
- Drug discrimination by insurers.
Where they differ is on how to fix them. Bernie Sanders proposes a totally new system: one single-payer plan covering everyone. As we’ve said before, it could be a great idea, potentially solving every problem on that list (and then some) all at once. Still, single-payer doesn’t automatically mean that people would be better off. For example, if we simply moved everyone into traditional Medicare, which is a single-payer plan, most people would end up with higher out-of-pocket costs, and its low reimbursement rates could force providers out of businesses. To judge any plan– single-payer or otherwise– you have to look at how it balances benefits and costs; and in Sanders’ plan those key details are a mess.
Hillary Clinton’s approach on the other hand is to build on the ACA. Clinton doesn’t provide detailed cost estimates for her proposals, but they’re all small enough changes that it’s easy to imagine how they might be paid for. In a way though, this also highlights a problem: even if all of her proposals were in place, the major issues with our health system would still remain. In other words, unlike Sanders’ plan, the numbers add up– but they don’t add up to nearly enough. [click to continue…]
[This is the first post in a series on the health plans of the 2016 presidential candidates.]
Even before they released specific plans, it was obvious that Bernie Sanders and Hillary Clinton had very different philosophies for improving our health system. Clinton promised an incremental approach: new regulations and funding to fix issues that Obamacare missed, but otherwise keeping the current system. Sanders proposed something much more radical: eliminating private insurance entirely, and covering everyone under one single-payer system.
It’s a great idea in theory: everyone gets an insurance card that they can take to any doctor or hospital in the country. No more worrying about whether you have insurance, whether a provider is in-network, or whether your claim will be denied. Single-payer also saves money thanks to lower administrative costs– hospitals don’t have to bill hundreds of different insurance plans, each with their own rules– and by negotiating for better prices from drug companies. Canada and a few other countries have shown that a national single-payer plan can work; they spend much less per person on care than us while covering everyone.
The hard part is figuring out how to get there from our current system. To switch to single payer you need to (1) figure out what services will be covered for every single American, keeping in mind that every benefit makes the plan more expensive; (2) set taxes and out-of-pocket costs so they’re affordable for every family; and (3) decide what to pay providers (set prices too high and the system is too expensive to sustain, set them too low and you force some doctors and hospitals out of business). Balancing all these variables is tricky, especially since the numbers are enormous. Over the next ten years we’re expected to spend over $40 trillion on health care, so a few percentage points here or there can mean the difference between a working system and an economic crisis. [click to continue…]
For his final state of the union, President Obama said he’d go easy on the traditional list of proposals for the year ahead. Instead, he said, he wanted to talk about “the next five years, the next ten years, and beyond.” And so, while he talked about the programs enacted during his time in office– including, of course, Obamacare– and the issues he’ll work on during his last year, but he didn’t lay out much in the way of specific plans. Still though, the health issues he talked about were telling, and there were some surprises.
Here, for the last time under an Obama White House, is our annual look at healthcare in the State of the Union. [click to continue…]
If you really think about it, the politics surrounding the Affordable Care Act have always been weird. The ACA was modeled on Massachusetts’ health reform, which was signed into law by future Republican presidential candidate Mitt Romney and supported by conservative think tanks like the Heritage Foundation. It’s also very similar to a plan proposed by Republican senators as an alternative to President Clinton’s health reform efforts in the early ‘90’s. So in theory, Republicans should have had no problem with Obamacare. Instead, Romney, the Heritage Foundation, and every other Republican in Congress came out against it.
But lately the politics of the ACA have gotten even stranger.
There are basically two parts to Obamacare’s coverage expansion: (1) Medicaid for those with incomes below 138% of the federal poverty line, and (2) exchanges where anyone who isn’t covered by an employer or government program like Medicare can purchase private insurance. Of the two parts, you’d think that Republicans would want to see more people enrolled in private insurance and fewer people enrolled in a big government health plan like Medicaid.
Yet, over the past month, we’ve seen Republicans across the country push to expand Medicaid, while their colleagues in Congress work to blow up the ACA’s private insurance expansion. [click to continue…]
Even among supporters of the Affordable Care Act, the law’s “Cadillac tax” on expensive employer-provided health plans has never been popular. Unions hate it because in many cases it will be their members’ health plans that are hit, and all three Democratic presidential candidates have called for its repeal. Meanwhile, on the other side, big corporations don’t like it either, since it could force them to choose between cutting back on benefits or paying more for healthcare, and a number of prominent Republicans, like House speaker Paul Ryan, want to repeal it as well.
Really it seems like the only people in favor of the Cadillac tax are economists– but they really like it. One hundred and one economists signed an open letter saying that it will lower health spending and asked Congress to “take no action to weaken, delay, or reduce the Cadillac tax until and unless it enacts an alternative tax change that would more effectively curtail cost growth.” It was signed by economists from across the political spectrum– everyone from the right-leaning American Enterprise Institute and former Bush administration officials to the left-leaning Center on Budget and Policy Priorities and former Obama advisors.
Usually if there’s a fight with a huge bipartisan group of policy wonks united on one side versus politicians and special interests on the other it’s a no-brainer: go with team wonk. But on this issue, we’re not so sure– it seems like the economists might actually be on the wrong side of this one. [click to continue…]
It’s open enrollment time for the Affordable Care Act, which means that now through January 31 anyone who needs coverage can buy a plan. The ACA means that millions more Americans can get affordable coverage, but shopping for health insurance can still be incredibly confusing and stressful. Don’t worry though: to help make the process a little easier, we have a new guide to getting covered under Obamacare for 2016! [click to continue…]
Surprisingly this guy, Martin Shkreli, is not a great person.
Hey, it’s been a while! Sorry for being MIA recently– we’ve been working on a big project for another, non-healthcare site. Luckily late summer is usually a slow time for health news, and this year was no exception. In what’s becoming an annual tradition, some journalists freaked out about proposed Obamacare rate hikes, but it’s still too early to say what rates regulators will approve in most states (they will almost certainly be lower). Some of the 2016 presidential candidates released health plans, but with the election over a year away, it’s too early to pay much attention (for example, Scott Walker, who put out one of the more detailed plans on the Republican side in August, has already dropped out).
There was one story that caught our attention though: a small startup jacked up acquired a drug used to treat life-threatening infections in AIDS patients, and jacked up the price by 5,000% overnight. It touches on the biggest problems with the prescription drug industry, and the outrage that ensued might even generate enough momentum to fix some of them. [click to continue…]
Last month marked the anniversary of the shooting of Michael Brown by a police officer in Ferguson, Missouri, and with it, the birth of the Black Lives Matter movement. Since then, we’ve seen time and again how the conscious and unconscious biases of police officers mean that black Americans are disproportionately targeted and much more likely to be killed or injured by the police.
But interactions with law enforcement aren’t the only time racial stereotyping can lead to injuries or even death for people of color. As this excellent article by April Dembowsky of KQED (in partnership with Kaiser Health News and NPR) illustrates, in medicine too, the unconscious biases of doctors are a major factor in the disparity in treatments and outcomes between white patients and black and Latino patients– a gap that new training programs hope to address. [click to continue…]