Let’s get this out of the way up front: This article will not be one expressing any particular political opinions. Instead, I want to talk about something that anyone reading this blog would presumably feel quite passionately about: healthcare. Whether you’re a Republican, Democrat, or Independent, you likely have some opinion on topics like Obamacare, Medicaid, and single party systems. But do you know how each candidate’s policies would impact our healthcare landscape? How feasible are their plans? While this is in no way a one stop spot for learning everything about our healthcare system and the impending decisions affecting it, it’s certainly a good place to start.

What is Obamacare?

Before this discussion can begin, let me first offer a brief overview on a question I frequently hear: What is Obamacare?  Well for one thing, it’s technically not called Obamacare but is officially known as the Patient Protection and Affordable Care Act … or the Affordable Care Act (ACA) for short. Moving past anyone’s personal opinions on this, the ACA was enacted with the intention of increasing the quality and affordability of health insurance, lowering the uninsured rate by expanding both public and private insurance coverage, and reducing the costs of healthcare for individuals and the government. Briefly, some of the significant reforms include:

1. Prevention of insurers from denying coverage to individuals due to pre-existing conditions
2. Dependents are allowed to remain on their parents’ insurance plan until age 26
3. The establishment of the Hospital Readmissions Reduction Program, which seeks to reduce hospital readmissions and penalizes hospitals with higher than expected readmission rates through decreased Medicare reimbursement
4. An employer mandate that requires businesses with 50 or more employees to offer health insurance to full time employees — lest they incur a tax penalty
5. Medicaid eligibility expansion
6. An individual mandate that requires all individuals not covered by an employer sponsored health plan, Medicaid, Medicare, or other public insurance programs to secure an approved private insurance policy or to pay a tax penalty.

Needless to say, there have been many objections to the Affordable Care Act — far too many for us to discuss here. And while I do plan to address a lot of this in a future blog post, let’s at least agree for now that the ACA has had a significant impact on healthcare workers. While it is arguably a good thing for more people to have access to quality healthcare, it has further exacerbated the physician shortage that we have heard so much about.

Additionally, by placing a greater emphasis on quality of care, prevention of complications, and readmission reduction — many physicians may feel that they have lost some degree of autonomy and that medical decision making is now a balance between the best interests of the patient and that of the hospital. Moreover, these increased regulations have certainly lead to an increase in paperwork. Like it or hate it — there’s no denying that the Affordable Care Act impacts us as physicians. But where do we go from here? Let’s now examine each candidate’s individual philosophies.

The Republican

Ignoring the endless amount of possibilities that could arise in a contested convention, let us limit this discussion to Donald Trump.

Donald Trump

“I would end Obamacare and replace it with something terrific, for far less money for the country and for the people” is how Donald Trump most recently described his healthcare plans.

Like many Republicans, Donald Trump views the Affordable Care Act as an economic burden that has generated higher premiums, less competition, and fewer choices. Thus, Donald Trump is in favor of repealing the Affordable Care Act. He notes that his goal is to follow free market principles to create public policy that will broaden healthcare access, make healthcare more affordable, and improve the quality of care available to all Americans. This plan includes:

• modifications of “existing law that inhibits the sale of health insurance across state lines”
• allowing individuals to fully deduct health insurance premiums from their tax returns
• allowing individuals to use Health Savings Accounts with tax-free contributions
• a requirement for price transparency from all healthcare providers
• removing barriers to entry for drug providers that offer safe, reliable, and cheaper products

Additionally, Donald Trump seems opposed to providing healthcare to illegal immigrants as he estimates this costs “$11 billion annually.”  While he does not propose denying care — he believes that enforcing immigration laws will alleviate this burden.

At this point, most Republican candidates have dropped out of the race. However, if you are or were planning on voting for any Republican candidate, you’re voting to repeal the Affordable Care Act. Additionally, each Republican candidate described himself as pro-life and generally opposed to abortion. However, while Ted Cruz opposed all exceptions to the anti-abortion stance, both Donald Trump and Governor Kasich support exceptions for rape, incest, and life of the mother. Finally, while Senator Cruz and Governor Kasich were outspoken in their stance that Planned Parenthood should be defunded, Donald Trump is less clear on his opinions here and has noted that he believes that Planned Parenthood does offer some beneficial services.
 

The Democrats

Coming down the home stretch of this article, let’s look at how Hillary Clinton and Bernie Sanders would each approach healthcare if elected President.

Hillary Clinton

“As president, I’ll defend the Affordable Care Act, build on its successes, and go even further to reduce costs. My plan will crack down on drug companies charging excessive prices, slow the growth of out-of-pocket costs, and provide a new credit to those facing high health expenses” is how Secretary Clinton outlined her healthcare policy in January 2016.

Additionally, per her campaign’s website, she hopes to protect women’s access to reproductive healthcare, contraception, and legal abortion.  In addition to the above, Secretary Clinton makes several points about how she plans to expand the Affordable Care Act, including:

• Expand access to affordable healthcare to families regardless of immigration status
• Lessen out of pocket expenses for consumers purchasing Obamacare on open exchanges
• Support expansions encouraging states to expand Medicaid
• Expand delivery reforms that reward provider quality care

As you can see, Secretary Clinton hopes to expand upon the Affordable Care Act with the biggest addition being a plan to make it available to all persons within the United States, regardless of their citizenship status.

Bernie Sanders

While Senator Sanders did vote for the Affordable Care Act, he ultimately believes that it has not gone far enough and instead believes that we need universal healthcare through a Medicare-for-all single-payer system. For anyone interested in what exactly universal healthcare is, you can read more about it here. This system, most similar to what is in in place in Canada, would automatically enroll all Americans in Medicare. By doing this, the government can attempt to control costs by negotiating a fee schedule with healthcare providers, utilizing its leverage to negotiate more affordable prices. Quoting economist Gerald Friedman, Senator Sanders believes that the US “could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion).”  It is not unreasonable to believe that Senator Sanders’ plan would affect physicians by increasing administrative tasks, decreasing total reimbursement, decreasing overall income, and dissuading pharmaceutical research and advancement.

The question is… How would we pay for this?

Here, Senator Sanders proposes imposition of broad-based taxes: a 6.7% payroll tax on employers and a 2.2% tax on individual incomes under $200,000 or joint incomes under $250,000 (with progressively higher rates for higher-income earners). Despite the tax increase, he believes that this would save the average American family $3855 to $5173 annually. However, he fails to account for the fact that this 6.7% payroll tax would likely come out of workers’ wages. Nor does he completely address what will become of deductibles and co-pays. Adjusting for this, his plan would likely save the average family $505 to $1823 a year.

Another point of contention is that Senator Sanders’ plan still comes up ~ $599 billion short of what the country actually spends on healthcare. He believes that his system would make up for this by trimming costs, but his plan would require that costs be trimmed by 42 to 47 percent. Ultimately, his plan may require higher taxes then previously estimated. 

Regarding other issues, Senator Sanders believes that the government should not be involved in decisions on abortion, that mental health care access should be expanded, and that planned parenthood provides a valuable service.

Ultimately, both Democrat candidates want to expand healthcare to all persons within the United States. They just have very different plans for how to do it.

In closing, I hope this article can provide everyone with a brief overview of the healthcare policies of each candidate and how they could affect the US healthcare landscape as well as healthcare providers. And if all else fails, check out this handy chart summing up things below.

The Overly Simplified Healthcare Policies of Each Candidate: