Presidential Candidate Plans to Improve Public Health & Extend Access

February 8, 2016

The Medical Society queried all presidential candidates on four issues impacting Granite Staters health and wellbeing.  The following are answers from candidates who who responded and were still actively in the race at the time of this posting.  NHMS encourages all physicians, PAs and students to review their responses, and take the Bartlett Jack Flip Challenge.                             

To extend affordable health care and improve public health, how would you improve, build upon, or offer as an alternative to the current federal systems?

Bernie Sanders – "The Affordable Care Act was a critically important step towards the goal of universal health care. Thanks to the ACA, more than 17 million Americans have gained health insurance. Millions of low-income Americans have coverage through expanded eligibility for Medicaid that now exists in 31 states. Young adults can stay on their parents' health plans until they're 26. All Americans can benefit from increased protections against lifetime coverage limits and exclusion from coverage because of pre-existing conditions. I was on the U.S. Senate committee that helped write the ACA.

But as we move forward, we must build upon the success of the ACA to achieve the goal of universal health care. Twenty-nine million Americans today still do not have health insurance and millions more are underinsured and cannot afford the high copayments and deductibles charged by private health insurance companies that put profits before people.

The U.S. spends more on health care per person per year (nearly $10,000), and as a percentage of gross domestic product, than any other advanced nation in the world. Other industrialized nations are making the morally principled and financially responsible decision to provide universal health care to all of their people - and they do so while saving money by keeping people healthier. Those who say this goal is unachievable are selling the American people short.

My plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. My plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications and medical equipment. Patients will be able to choose a health care provider without worrying about whether that provider is in-network, and health care providers will be able to offer the best treatment for their patients regardless of that patients' insurance status or ability to pay.

As a patient, all you need to do is go to the doctor and show your insurance card. My plan means no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges.

Creating a single, public insurance system will go a long way towards getting health care spending under control. The United States has thousands of different health insurance plans, all of which set different reimbursement rates across different networks for providers and procedures resulting in high administrative costs. In fact, a great deal of research showing the geographic differences in health spending has been conducted in New Hampshire at the Dartmouth Institute for Health Policy and Clinical Practice. Two patients with the same condition may get very different care - pay very different amounts for the same care - depending on where they live, the health insurance they have and what their insurance covers. Health care providers and patients must navigate this complex and bewildering system wasting precious time and resources.

By moving to an integrated system, the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively. It will also ensure the federal government can track access to various providers and make smart investments to avoid provider shortages and ensure communities can access the providers they need. We need to ensure a strong health care workforce in all communities now and in the future. We need to build on the strength of the 50 years of success of the Medicare program.

We need a health care system that significantly reduces overhead, administrative costs and complexity. We need a system where all people can get the care they need to maintain and improve their health when they need it regardless of income, age or socioeconomic status. We need a system that works not just for millionaires and billionaires, but for all of us.

My plan will cost over $6 trillion less than the current health care system over the next ten years and will pay for new public spending with:

  • employer-paid premiums (6.2% of salary instead of the high monthly contributions paid now);

  • premiums paid by households (2.2% of taxable income instead of the monthly premiums taken from your paycheck now);

  • income tax increases on the richest 2.1% (higher marginal tax rates and other reforms mainly affecting incomes over $500,000); and

  • estate tax reforms affecting the wealthiest 0.3% of families.

    Businesses would save over $9,400 a year in health care costs for the average employee. The typical middle class family would save over $5,000 under this plan. Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program. That amounts to a savings of over $5,800 for that average family each year."

Hillary Clinton – "The response to Medicaid expansion in New Hampshire shows how important the Affordable Care Act has been for the millions of Americans who need access to quality, affordable health care – including over 40,000 New Hampshire residents who were able to enroll under Medicaid expansion. I understand that the budget compromise reached in September by Governor Hassan and legislators does not include re-authorization, and that the Governor is taking Republican leadership at their word that they will take up re-authorization as soon as possible.  I think Governor Hassan is right to push for making the expansion permanent.

As I have said many times in my campaign, I am committed to defending and building on the Affordable Care Act to make coverage more affordable and accessible. We do that, first, by getting spending under control, so my plan will make families’ insurance more affordable through increased relief for out-of-pocket spending and caps on prescription drug costs, while at the same time working to slow the rise in health care costs. We have a real chance to build upon the achievement of the ACA, get our spending under control, and continue to increase access for millions of Americans. As president I will continue this fight."

John R. Kasich – Access to affordable health care, is a top priority for Gov. Kasich. You can learn more about a few of his priorities here.

Jeb Bush – "ObamaCare enabled Washington control of more than one-sixth of the American economy, and it confiscated citizens ' ability to select a health plan, a hospital and even a doctor. It epitomizes why Americans are so fed up with Washington. Government inserts itself into our daily lives, fails to keep its promises, fails to recognize unintended consequences, spends trillions of dollars the country does not have, disrupts the lives of millions of Americans and leaves many worse off. Americans are frustrated - and they have a right to be.

I worked with physicians in Florida to achieve transformational reforms -such as medical liability reform, transparency, and Medicaid reforms that empowered patients. And as President of the United  States, I would make fixing our broken health care system one of my top priorities. I believe health care reform should actually lower costs. Physicians should be able to lead on solutions that help patients, lower costs and improve access to care - just like American ingenuity does in other sectors of the economy.

ObamaCare must be repealed and replaced, and I'm the only Republican candidate in the race with a plan to do that and position American health care for the possibilities of the 21st century. My plan will get Washington out of the way and empower patients with more choices, security and control over their health care decisions. These reforms will not only lower the costs of care, they will substantially lower federal spending. They will enable a modem system that is convenient, affordable, accessible and results-oriented."

Chris Christie – "Governor Christie believes that Obamacare has been a total failure. As president, he would repeal Obamacare and send it all back to every state. Every state in this country is different. Every state has different challenges.

The Constitution says that if the power is not listed in there for federal government, it goes back to the states. I have read the Constitution. I don't see health care anywhere in there. It needs to go back to the states and the states should have one year to come up with their plan, the governors and the legislatures. And then you can have the most effect on it.”