On the issues: Clinton and Trump take familiar partisan positions on healthcare

Clinton Trump

WASHINGTON (UPI) — On the issue of healthcare, Donald Trump, and Hillary Clinton have fundamental differences in what they would do to reduce the cost of private insurance and increase access to care for millions who remain uninsured.

For starters, Trump calls for the complete repeal of President Barack Obama‘s Affordable Care Act. Hillary Clinton supports it but wants to improve on it.

Data show some 33 million Americans, or about one in 10, still lack health insurance, despite a government mandate to purchase it, largely because the fine imposed for failing to purchase coverage is significantly less the cost of the insurance itself. Many younger Americans who do not make regular doctor visits take the cheaper way out and pay the fine.

Here is a look at how the candidates plan to address the nation’s healthcare system:

Trump toes GOP’s Obamacare line: ‘repeal and replace’

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Republican presidential nominee Donald Trump has repeatedly called for the uniform repeal of the Affordable Care Act, a top conservative priority since its passage in 2009. Only after that, he said, can Congress begin to implement the kinds of reforms that are needed to stop rising costs.

To do so would mean potentially booting the 10 million Americans off the plans they purchased through the federal government’s website, healthcare.gov, or through state-run health insurance exchanges because most Americans who have purchased the plans did so with the aid of tax breaks spelled out in the Affordable Care Act to make the policies affordable.

Trump’s plan does not call for keeping Obamacare’s off-the-top tax credits for health insurance in place presently.

Instead, the candidate proposes doing away with the government mandate requiring all individual to purchase insurance or face a fine, and introduces several new policies Trump said will reduce the cost of insurance without intensive government regulations.

They include:

— Ending the ban on interstate sales of health insurance. Presently, only insurers located in a state can sell insurance there. Trump proposes ending that ban and enabling carriers to compete in any state, provided the plans they sell conform to state regulations. Trump said this will increase competition in the free market and reduce prices.

— Make health insurance premium payments 100 percent tax-deductible. Trump argues individuals should be afforded the same tax breaks that employers receive for the contributions they make toward their employees’ insurance plans.

— Allow health savings accounts to be transferrable via inheritance and permit any immediate family member to use another member’s account without tax penalties.

— Force healthcare providers to be fully transparent in the cost of their services so consumers can price-shop for cheaper services.

— Allow drug companies to introduce cheaper forms of medications already on the market, reducing the cost of prescriptions.

Trump has also called for converting Medicaid, the government program extending health insurance to the poor and disabled, into an unregulated block grant to states that would then set their own parameters for administering the program. Presently, the federal government puts numerous requirements on states in order to receive Medicaid dollars.

Clinton renews Democratic push for a ‘public option’

Photo by Nell Redmond/UPI.
 One of Hillary Clinton’s most significant policy shifts over the course of her long primary campaign against Sen. Bernie Sanders was her proposal to renew Democratic calls for a so-called healthcare “public option” that would allow individuals to purchase a government plan similar to Medicare, that would compete with private insurers. She would also allow Americans ages 55 to 65 to buy into Medicare directly.

Clinton supported the public option during her 2008 campaign when she and then-Sen. Barack Obama debated vigorously over health care reform. At the time, Obama took Clinton to task for her inclusion of a controversial requirement that all Americans buy health insurance or face a financial penalty, though after coming into office, Obama embraced the government mandate, which was supported by health insurance companies, and included it in the Affordable Care Act.

One item that was eventually left out, however, was the public option. Liberals who preferred a government-run single-payer system touted the public option as a compromise that would allow those who wanted government health care to buy it, but moderate Democrats balked, arguing it would undercut the private health insurance industry and give the federal government to much control over healthcare.

Clinton has also championed several other pieces of Obamacare add-on legislation to address rising costs.

 She would empower the secretary of Health and Human Services to nullify large increases in insurance premiums if they are found to outpace the cost of providing care.

She has also made a number of proposals to reduce the cost of prescription medication. Clinton has called for an end to tax subsidies drug companies receive on marketing and requiring them to spend more on research and development of new medication. She has also said the federal government should intervene when drug companies dramatically increase the cost of medications, such as the recent controversies over the huge spike in the cost of emergency allergy injectors EpiPens. Clinton supports legislation that would allow federal regulators to fine drug companies that dramatically increase the price of potentially life-saving medications without cause, or by making small modifications to existing medications that do not substantially improve patient results.

Clinton has also called for legislation that would cap an individual’s out-of-pocket costs for medication at $250 as a means of providing financial relief to the chronically ill.

Another area where drug costs can be lowered, she says, is by streamlining the present government backlog in approving generic drugs for market. Presently, the Food and Drug Administration has some generic drug proposals that have been waiting years for approval. Clinton would beef up the FDA’s Office of Generic Drugs to eliminate the backlog and introduce less expensive options for patients.

Clinton also proposes increasing the amount the federal government spends funding community health clinics, where 25 million Americans gain access to free or affordable primary care, often in low-income neighborhoods. Those clinics, often staffed by enrollees in the National Health Service Corps, a government program that allows young doctors to enroll and have part of their medical school bills paid by the federal government in exchange for working as primary physicians in community health clinics that struggle to attract doctors because of the lower pay than large hospitals or what they could make in specialized private practice. Clinton proposes increasing funding for the National Health Service Corps to $810 million in 2017.