While there are a good handful or so of health care topics that are on the political agenda, one of the more polarizing -- and divided right along the party lines -- is the Affordable Care Act (ACA). At its most basic, the ACA is intended to reduce the amount of uncompensated care the average U.S. family pays for by requiring everyone who can afford it to have at least minimum essential health insurance coverage, or pay a tax penalty fee for every month without coverage. There are several exemptions from the penalty fee, including income that is below the tax filing threshold, as well as subsidies to help low-or middle-income individuals or families pay for health insurance coverage. The ACA also prohibits insurers from denying coverage or charging higher premiums to people with pre-existing conditions, or from selling plans without things such as maternity care, mental health treatment, or other services that an employer policy would typically cover. These prohibitions have caused some insurers, such as UnitedHealth, to recently pull almost completely out of most ACA exchanges because of losses of a few billion dollars – while other insurance companies are making money and looking to expand.
So how are the candidates split on this topic? At a very high level, Hilary Clinton supports the Affordable Care Act and aims to continue growing and expanding the program, along with continuing to work toward a single-payer system providing coverage for all. Donald Trump would like to repeal the ACA and replace it with free-market competition, as well as eliminate the requirement for every person to purchase health insurance or face penalty fees. Gary Johnson has a very similar stance as Mr. Trump, and Jill Stein supports single-payer, universal health care. There are, of course, many other important points that are expanded upon within each of the candidate’s health care platforms.
Along with health insurers jumping the ACA ship, another health care topic in the news has been the soaring costs of prescription drugs – most notably the EpiPen, which has recently increased in price by more than 400%. However, EpiPens aren’t the only drugs that have had exorbitant price increases and name-brand pharmaceuticals aren’t alone – generic drugs have seen the same pattern. In fact, the United States pays the highest prices in the world for prescription drugs.
In a poll done by the Kaiser Family Foundation, nearly 72% of Americans indicated they thought that drug prices were unreasonable, but the exact reason or combination of reasons for why the costs are so high are hard to pin down. Pharmaceuticals indicate high prices reflect research and development costs in bringing a drug to the market. Some will argue that our complex heath care system is to blame for rising prices, while others argue that there is simply no system in place for managing the prices of pharmaceuticals. Most consumers believe that drug companies spend more on advertising than they do on research, and that drug companies put profits before anything else.
The presidential candidates can agree on one thing here, and that is that the costs of pharmaceuticals need to be reined in. Hilary Clinton has proposed a ‘crack down’ on drug companies who raise prices and a reward for investing in research. Donald Trump also believes in an approach to hold drug companies accountable for rising prices and promotes free-market principles to reduce costs. Both have also talked about allowing for import of prescription drugs from other countries.
There are several other important health care topics under this year’s political umbrella including:
- Enabling and advancing medical research
- Drug and alcohol addiction treatment
- Mental health treatment
- Zika virus
Tuesday, November 8, 2016 will be here before we know it, and healthcare as we know it could change quite a bit. In the meantime, if you’re covered under Medicare or the Affordable Care Act, open enrollment begins November 1, 2016 and ends January 31, 2017. During open enrollment, anyone that applies for health insurance and is eligible must be accepted by the health plan. It’s also a good opportunity to make changes in your health coverage to better suit your needs.
This article first appeared in the September 2016 edition of the HealthPerks newsletter.