Health Care: the Undebated Issue of the 2016 American Presidential Elections
Par Dr.Sabrina Germain, Lecturer in Law and Public Policy at the University of Surrey
The 2016 American presidential election is unique in many aspects and has given rise to unprecedented controversy. Unfortunately, one of the consequences of the polemic has been to have some key issues, such as health care, left in the background. Despite addressing the civil rights issue of abortion during the presidential debate of October 19, health care policy has not been at the forefront of the candidates’ rhetoric to mobilise voters. Hillary Clinton, candidate for the Democratic Party, and Donald Trump, candidate for the Republican Party, have nonetheless taken a stance on some health care issues during the course of their campaign.
With only a few weeks before the vote we should take the time to evaluate their respective plans. Both candidates will be dealing with major issues such as the sustainability of the Patient Protection and Affordable Care Act (Obamacare), the expansion of Medicaid and the excessive price of pharmaceuticals. They will also be pressed to offer concrete solutions to public health emergencies such as the Zika virus.
First, a few things should be said about the state of American health care policy. Statistics show that for the first time in history nine out of ten Americans are covered by health insurance, although this is a significant achievement on the part of the Obama administration, millions of Americans are still uninsured. Progress is substantial but incomplete as health care costs remain important and insured still face high co-payments and deductibles. Prescription drugs prices have spiked and the quality of care is uneven throughout the country. Republicans also continue to fiercely oppose Obamacare and a Gallup poll conducted last August shows that 51 per cent of Americans disapprove of this reform.
However, if Hilary Clinton was to become the 45th president of the United States, she would maintain and push further the Obamacare agenda and this could translate in a similar gridlock with the Republican-controlled Congress as the one experienced by President Obama during his presidency. On the other hand, a Republican White House with Donald Trump as president would likely equate to an instantaneous repeal of the current health care legislation as the President would have full support of Congress if the Republicans were to maintain control of both houses.
Sustainability of Obamacare
Hilary Clinton has been presenting herself as the candidate of continuity in the realm of health care. Although her program builds on the existing system she also proposes a few changes as she intends to repeal the “Cadillac tax” on generous coverage (penalising employers that offer high-cost health plans to their employees and executives) and is suggesting to decrease out-of-pocket costs for individuals and families by taking care of the “family glitch”. The latter is one of the most pressing issues affecting many families in the United States. Employees’ family members struggle to find coverage on the insurance exchange platforms set up in 2014 because they are not taken into account when determining subsidies. Clinton also advocates allowing Americans over 55 to enrol in Medicare and increasing funding for research on autism and dementia. It may appear to be a rather conservative agenda but it is not the easiest plan to execute.
Opposite side, Donald Trump would repeal the current health care law and put in place a free-market system legalising the purchase of insurance policies across state lines. He would also allow individuals to deduct insurance premium payments from their tax returns similarly to businesses that already benefit from these deductions. Critics have accused him of wanting to harm the population as his policy could lead 18 million people to become uninsured without lowering insurance prices. To this Trump responds that he would not to have people “die on the streets” since he would be “working out deals” with hospitals to provide care for uninsured patients. He also does not intend on cutting Medicare as a programme. However, in an effort to decrease health care spending, Donald Trump has made the highly controversial suggestion to reduce illegal immigrants’ access to care. It is not clear whether in reality this proposition would even lead to significant savings.
Expansion of Medicaid
Medicaid is a publicly funded state-administered program offering health care coverage to low-income adults and children and persons with disabilities in the United States. The current health care legislation encourages states to expand the Medicaid coverage to encompass a greater portion of the population than is required by federal guidelines.
Presidential candidates strongly disagree on the expansion policy and the management of this strained program. Hilary Clinton wishes to incentivize states that have opted-out of the expansion to join in on the effort and provide more low-income Americans with health care coverage.
Donald Trump for his part intends on scaling down the program. Instead states would be provided with block grants allowing them to design their own health care programs and spend the federal money at their discretion to ultimately benefit the local low-income population.
Excessive Drug Prices
Pharmaceuticals prices are soaring and pose a serious threat to the American economy. The topic has mobilised the public’s attention and both candidate are aware, concerned and willing to tackle the problem. Hilary Clinton proposes to cap the out-of-pocket cost of drugs and to hold pharmaceutical companies accountable for better research but not greater profits. She plans on creating legal powers to negotiate prices with pharmaceutical companies and bar manufacturers from keeping generic drug makers off the market. She also proposes to allow the import of drugs from Canada.
Donald Trump also supports the drug imports and advocates removing barriers to create a free market for companies that offer safe, reliable and cheaper pharmaceutical products. He also proposes to have Medicare negotiate lower prices with the industry.
Public Health Emergencies
The Zika virus crisis affecting Latin America has been in the background of the electoral campaign throughout the summer since a lot of cases have also been detected in southern US states. Candidates have expressed their concerns and taken the opportunity to offer methods to tackle the epidemic. Clinton called for the allocation of 1.8 billion dollars to an emergency fund and dispatched two of her aids to Puerto Rico to meet with medical professionals on site.
As President she believes that a “Public Health Rapid Response Fund” could reduce the response time from the government and make a difference in tackling public health emergencies such as pandemics, climate change or potential bioterrorism. This way, no Congressional approval would be required making the money immediately available.
Trump of course agrees with Clinton, the government should help irradiate Zika. He promised that when he takes Office he would release some funds to help fight the virus but concedes that it may be hard to eliminate.
In the light of issues and solutions laid-out it seems like Clinton is presenting a broad-stroked plan and Trump no clear policy line for health care. The lack of debate and clarity on the issue is rather alarming for a developed western state that sadly still struggles to provide its population with good access to care.
Ce contenu a été mis à jour le 20 septembre 2017 à 12 h 18 min.
un projet de la Chaire L.R. Wilson