Questions for Republican Candidates on Obamacare

Affordable Care Act

Questions for Republican Candidates on Obamacare

Published on April 27, 2016

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THIS ARTICLE IS NOT INTENDED TO BE POLITICAL.
For each candidate, we examined the health care reform plans they have on their web sites. We then took their plans and created a grid that highlights areas where candidates agree and disagreement or have differences.
After the grid we look at each issue, and pose one (hopefully) fair and thoughtful question we’d like the candidates who support it to answer.
Here are the Republicans:

Candidate/
Reform Plan
The Trump Plan
(Link)
Ted Cruz’s Health Care Choice Act
(Link)
The Rubio Plan
The Kasich Plan
(Link)
Interstate
Competition
Yes
Yes
Yes
Not Found
Refundable
Tax Credits
Yes
Not Found
Yes
Not Found
Health Savings
Accounts (HSAs)
Yes
Not Found
Yes
Not Found
Provider Price
Transparency
Yes
Not Found
Not Found
Yes
Value-Based
Insurance
Not Found
Not Found
Not Found
Yes
International
Competition for Rx Drugs
Yes
Not Found
Not Found
Not Found
“Block Grant”
Medicaid to the States
Yes
Yes
Yes
Yes

.
So, let’s start with the first item on the list that is supported by three of the four remaining candidates:
Interstate Competition This is a consistent part of the Republican Party’s platform on health care reform. The GOP suggests that allowing insurance companies to sell health insurance across state lines would increase competition, give consumers more choices and drive down costs.
Trump and Rubio support this idea. John Kasich is the only candidate who doesn’t specifically call this out as a part of his plan to improve health care in the United States. A fair question to ask candidates who support this position is:
Q: What role would the state’s play? Today, each state’s department of insurance (DOI) reviews the insurance policies offered in their state. Two very important things that each state DOI does is review prices (to make sure they’re fair and providing value) and network adequacy (do enough doctors and hospitals in the state accept the insurance to ensure that you can get cared for when you’re sick.) What role would a state’s department of insurance have if insurance is sold across state lines, and how would that effect the quality of the insurance products sold in that state?
Refundable Tax CreditsObamacare/ACA provides tax credits, but they’re limited to people with incomes below 400% of the Federal Poverty Level (FPL). And, applying for them can be difficult and complicated. Since 2014, health insurance premiums in the individual insurance market have gone up over 50% for those who do not qualify for tax credits. Ideally, offering a refundable tax credit to anyone who buys their own health insurance makes that insurance more affordable for more people.
Trump and Rubio support these tax credits. John Kasich and Ted Cruz don’t specifically address tax credits on either of their web sites. A fair question to ask candidates who support this position is:
Q: How would you pay for it? The ACA/Obamacare aims to pay for its tax credits, primarily, through new taxes on employers, taxes on “Cadillac insurance policies,” taxes on durable medical equipment and cuts to Medicare. Which of these taxes would the candidates support, or where would they cut to offset the additional costs?
Health Savings Accounts (HSAs)Health Savings Accounts (HSAs) were first approved by Congress in 2003 and became law in January 2004. An HSA is a tax-advantaged savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). Any money you contribute to an HSA is not subject to federal income tax at the time of deposit, or if you withdraw the funds and use them to pay for healthcare.
Trump and Rubio support this idea. John Kasich, and Ted Cruz don’t specifically call out HSAs on their web sites as a part of their plan to improve health care. A fair question to ask candidates who support this position is:
Q: What would be different? Health Savings Accounts (HSAs) are legal today. What, if anything, would you do to change HSAs going forward, and what would your specific changes to HSAs do to lower health care costs?
 
Provider Price Transparency The idea here is to require anyone who provides medical care – doctors, hospitals, etc. – to publish their prices online, so that people can use prices to help them pick the cheapest place to receive care. Ideally, this could help consumers with high deductibles find low-cost services like MRIs or blood test, to save money and drive business to lower cost, higher quality providers.
 
Trump and Kasich support this idea. Cruz and Rubio don’t specifically call this out as a part of their plans to improve health care in the United States. A fair question to ask candidates who support this position is:
Q: How will you get consumers to use these resources? The government has a history of building web sites and tools for consumer use that never gain much traction. Sites like “hospitalcompare.gov” and “physiciancompare.gov” – for example – have failed to gain a tremendous amount of mainstream adoption.
 
Value-Based Insurance This is a concept that aims to move away from a fee-for-service model in health care, where doctors and hospitals get paid for every test and/or service they provide. Instead, this is a “pay for performance” model, where doctors get paid more when their customers get healthy and/or stay healthy after a visit.
 
This is the cornerstone of John Kasich’s plan to reform health care. Trump, Cruz and Rubio don’t specifically call this out as a part of their plans to improve health care in the United States. A fair question to ask candidates who support this position is:
Q: How will this differ from “Accountable Care Organizations” (ACOs) created under the Affordable Care Act? How would the Kasich version of value-based insurance differ from ACOs and what changes need to made to improve performance in suburban and rural areas (link)?
 
Allow International Competition for Rx Drugs The idea here is to make prescription drugs cheaper by making it easier for drug manufacturers from other countries to sell their drugs in the United States. In theory, if consumers have access to more safe, dependable drugs – even if they’re imported from overseas – that will give people more choices, it will create competition, and eventually drive down prices.
This is part of Donald Trump’s plan to reform health care. Cruz, Rubio and Kasich do not specifically call this out as a part of their plans to improve health care in the United States. A fair question to ask candidates who support this position is:
Q: What impact would this have on the production of new drugs here in the United States? It’s estimated that 57% (more than half) of all “New Chemical Entities” (NCE’s – these are the building blocks of new drugs) originate from U.S.-based companies (link). If the U.S. begins allowing foreign drug companies to sell their drugs here in the U.S., would it mean that the number of new drugs created in the U.S. would decline?
 
“Block Grant” Medicaid to the StatesSupporters of this idea argue that the Federal Government should have less control over how Medicaid dollars are spent at the state-level. Supporters argue that states should manage their Medicaid funds independently, because they know the needs of their citizens best.
All of the remaining GOP candidates support this block grant concept as a way to reduce the cost and improve care provided through the Medicaid program. A fair question to ask candidates who support this position is:
Q: What will happen if a state mismanages its Medicaid funds? Medicaid represents 17% of all health care spending in the U.S.;on average, Medicaid makes up 20% of each state’s budget; and under Obamacare (The ACA), the Federal Government increased its contribution to 90% of those costs by 2020 (for those states that agreed to expand Medicaid). Since 2014, and the passage of ACA, Medicaid enrollment has grown faster than anticipated (link). If a state mismanages its Medicaid funds, would the Federal Government bail them out?
Now, let’s look at the Democrats.

We’ll let you know when we publish anything new.