Washington Week

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Trump vs. Clinton: Health Care

By Jenna Goff and Joan Greve
Washington Week Fellows

In case you missed it, Hillary Clinton has pneumonia. The diagnosis follows concerns from the Trump campaign over her health and fitness to serve as commander in chief. Both candidates now plan to release detailed medical information to prove that they can, in fact, be president, leading to larger questions about where the candidates stand on health care in general.

As the general election heats up, Washington Week is covering the candidate’s stances on major issues. We’ve covered topics from immigration to gun control, and this week we take a look at health care.

 

Affordable Care Act (Obamacare)

Obamacare has long been a contentious point among Trump and Clinton, as the candidates have almost completely contradictory views on President Obama’s signature legislative achievement.

Donald Trump has repeatedly pledged to “repeal and replace Obamacare with something much better,” and has even said that he would ask Congress to repeal the law on the very first day of his administration. He views the Affordable Care Act as an economic disaster that has resulted in “websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.”

Despite claiming in February that he liked the individual mandate to buy insurance that is included in Obamacare, Trump unveiled a plan to completely replace Obamacare in March. His platform now states that no person should be required to buy insurance unless they want to. Trump also seeks to allow the sale of private health insurance across state lines to increase market competition and ideally lower insurance costs. He would also lower costs by enforcing immigration reform that would then stop providing health care to undocumented immigrants.

Hillary Clinton, on the other hand, is a staunch supporter of the Affordable Care Act and would expand it under her presidency. Rather than repealing and replacing Obamacare, Clinton would revise it, while building “on its success to bring affordable health care” to “20 million people.”

Her long-standing pledge to support the public option has likely drawn the most attention. The creation of a government-run plan to compete with private insurers is not currently included in the Affordable Care Act. Clinton plans to establish the public option by beginning at the state level, which would not require additional legislation but would necessitate funding.

Clinton additionally wishes to broaden the reach of Obamacare to cover previously excluded populations, including the families of undocumented immigrants. She would make health care more affordable, allowing more people to be insured. “What I do want to see is that we have more options for undocumented people to be able to get the health care they need," Clinton explained in March. "It's not only the right and moral thing to do for them. It's also important that we keep ourselves healthy.” She has also pledged to extend quality, affordable health care to Americans in rural locations.

 

Affordability of prescription drugs

Prescription drug sales increased by 11.7 percent between 2014 and 2015, while patients’ out-of-pocket costs climbed nearly as much. Both candidates have addressed this issue and have also promised to make overall health care more affordable.

Clinton, per her platform, would “promote competition and leverage our nation’s bargaining power to lower drug costs on behalf of Americans.” To do so, she would get more generic drugs on the market and create a “federal backstop” for high-priced drugs that face no competition. She would also place a cap on what insurers can charge consumers in out-of-pocket costs and stop direct-to-consumers drug advertising by denying subsidies. She believes this last measure would eliminate corporate write-offs for advertising, saving the government billions of dollars that could be used to invest in drug research. Clinton has additionally proposed allowing foreign drugs to enter the market, but only “with careful protections for safety and quality.”

Trump’s plan to reduce the cost of prescription drugs is remarkably similar. Both candidates have said that they support Medicare negotiating directly with prescription drug companies to get lower costs. In February, Trump claimed that “we pay about $300 billion more than we are supposed to, than if we negotiated the price.” While these savings are most likely an exaggeration, as fact checked by the Washington Post, Clinton’s platform also outlines her plan to allow Medicare to use its leverage to drive down drug prices.

Trump also believes in increasing competition and lowering costs by allowing Americans to purchase and consume imported drugs. His platform states that Congress should “remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products.”

 

Reproductive health

Clinton has, at times, provided underwhelming support to the abortion rights community, such as when she told a family planning conference in 2005, "We can all recognize that abortion in many ways represents a sad, even tragic choice to many, many women." But, during this campaign cycle, she has come out strongly in favor of abortion rights and providers, such as Planned Parenthood, who also offered her their endorsement during the Democratic primary. 

On the 43rd anniversary of the Roe v. Wade Supreme Court decision, Clinton’s campaign also issued a statement promising that she would protect Planned Parenthood from federal defunding and work to repeal the Hyde Amendment, which outlaws the use of Medicaid insurance to cover abortions. And the Democratic nominee has made her support of the Affordable Care Act, which covers contraceptive methods and counseling, a central tenet of her health care plan.

Trump’s policy on reproductive health has been met with skepticism by many conservatives, given Trump’s pro-choice history. The Republican nominee did not come out as strongly pro-life until 2011, when he began to consider a presidential run. Years before that, Trump hosted a fundraiser for an abortion rights leader at the Plaza Hotel and even told the late Tim Russert of NBC that he was “very pro-choice” in a 1999 interview.

But Trump has tried to align his reproductive health views with the Republican Party during this election--with a few stumbles along the way. During a March town hall with MSNBC’s Chris Matthews, Trump said that, if abortion were outlawed, women who sought the procedure should be subject to “some form of punishment.” His campaign quickly walked back the statement, issuing a press release which clarified that, if abortion were ruled illegal, “The doctor or any other person performing this illegal act upon a woman would be held legally responsible, not the woman. The woman is a victim in this case as is the life in her womb.”

Despite his pro-life stance, Trump has a slightly softer view on abortion than conservatives such as Ted Cruz. The GOP nominee told NBC’s Savannah Guthrie in April that he would allow exceptions for abortion in the case of rape, incest or a threat to the woman’s life.

Trump has also somewhat split with conservatives over Planned Parenthood. While many GOP politicians have called for federally defunding the abortion provider, Trump has repeatedly praised the other services offered by Planned Parenthood, saying in March, "Planned Parenthood has done very good work for millions of women." Trump does still threaten defunding if the organization continues to provide abortions: "But we're not going to allow and we're not going to fund, as long as you have the abortion going on at Planned Parenthood.”

 

Mental health

The bulk of Trump’s mental health policy can be found in an unexpected part of his platform: Second Amendment rights. After promising to protect the right to bear arms, Trump’s platform proposes that he will “fix our broken mental health system.” The section continues, “All of the tragic mass murders that occurred in the past several years have something in common – there were red flags that were ignored. We can’t allow that to continue. We need to expand treatment programs, because most people with mental health problems aren’t violent, they just need help.”

The Republican nominee also devotes a paragraph of his health care reform plan to the issue, writing on his campaign website, “Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones.”

Clinton rolled out her mental health plan in August, calling for “integrating our health care systems and finally putting the treatment of mental health on par with that of physical health.” The plan was comprehensive, covering everything from criminal justice reform to suicide prevention to quality of health insurance.

For starters, Clinton has pledged that she will “convene a White House Conference on Mental Health within her first year in office, to highlight the issue, identify successful interventions, and discuss barriers that must be removed to improve today’s system.” The Democratic nominee has stressed the need for early mental health intervention, from infancy all the way through college.

She has also proposed partnering with the Surgeon General on suicide prevention, creating a cross-agency government initiative between three Cabinet departments: Health and Human Services, Veterans Affairs and Education.

Clinton borrowed a page out of former primary rival Bernie Sanders’ playbook by calling for the “creation of high-quality, comprehensive community health centers in every state.” She has even tied her criminal justice reform policies to mental health, aiming to “prioritize treatment over punishment for low-level, non-violent offenders with mental illnesses.”

 

Medicaid

To expand or not to expand, that is the question of Medicaid. Clinton has promised to work with Republican governors who are “leaving too many Americans without health insurance even though they qualify for coverage.” She calls for expanding the health insurance program, which offers coverage to low-income Americans, and for easing the enrollment process.

The passage of the Affordable Care Act allowed states access to more federal funding if they  expanded their Medicaid programs, but many Republican governors refused to do so in their states. Clinton’s campaign says that they will address this discrepancy, writing on its website, “It is a disgrace that 19 states have left 3 million Americans without health insurance because their states have refused to expand Medicaid.”

The most common argument against Medicaid expansion has to do with costs. When Utah attempted to expand their Medicaid coverage in October, the state House of Representatives voted it down because, as House Speaker Gregory H. Hughes told local newspaper The Deseret News, “Everybody loves expanding Medicaid until they have to pay for it.”

Trump has sided with many Congressional Republicans on how to address Medicaid’s escalating costs: block grants to the states. This plan, proposed multiple times since the Reagan administration, would allow states to receive lump sums of federal funding for social programs. The recipient states would then individually decide how best to allocate the funds because, as Trump argues in his platform, “The state governments know their people best and can manage the administration of Medicaid far better without federal overhead.”

Advocates of the plan say that increased flexibility in Medicaid spending would allow states to more effectively spend the money and provide a higher quality of care. But opponents have argued that, without federal oversight, social programs like Medicaid would become “an easy target for cuts” and quickly lose funding.

If that were to happen, Trump could rely on his other health care plan: jobs. The Republican nominee writes in his platform, “To reduce the number of individuals needing access to programs like Medicaid and Children’s Health Insurance Program we will need to install programs that grow the economy and bring capital and jobs back to America. The best social program has always been a job."