The Candidates' Stances on Health Care

Ref: John Kasich's campaign site:
 Obamacare is the Wrong Diagnosis and Must Be Repealed and Replaced:
 Access to affordable health insurance is an important priority but Obamacare has failed to achieve this because it has driven up the cost of health insurance approximately 80 percent in Ohio's individual and small group market and raised taxes to help subsidize health insurance coverage for families making up to $94,000 annually. Too often Obamacare mistakes treating symptoms for solving problems which only worsens the overall, long-term problem. John Kasich believes Obamacare must be repealed and replaced with efforts that instead improve access by actually lowering health care costs without interfering with Americans' personal health care decisions or imposing punishing burdens on job creators.
 The Real Problems Remain Unchanged: Americans get what we pay for in health care, and too often what we pay for is more care instead of better care. In many areas a predominantly fee-for-service system creates financial incentives for health care providers to perform more services for a person who is sick rather than work to keep that person healthy. As a result, an estimated one-third of America's health care dollars are wasted on things patients don't need (IOM 2009) and, at the same time, 55 percent of Americans have been found to go without recommended treatments for preventive care and chronic care management (NEJM 2003). The time has come for leadership to fix it.
 A New, Conservative Vision:
 In Ohio, health care purchasers, health insurance plans, and providers realize the current system is unsustainable and are working-together with Gov. Kasich's Administration-to explore new payment models that, instead of just rewarding volume, reward value that helps people stay healthier.

Better primary care (patient-centered primary care): The first step is having a primary care system that helps promote long term good health instead of just reacting when someone gets sick. Ohio is working through its Medicaid system to encourage patient-centered primary care practices that go the extra distance to keep people healthy and thereby help control costs. Savings generated this way accrues, in part, to health insurance plans as avoided costs. To help incentivize more robust participation in this model,Ohio's four largest commercial insurers-Anthem, Aetna, Medical Mutual and UnitedHealthcare-as well as Ohio's five Medicaid managed care plans, are designing a system that also shares those savings with the providers whose work helps improve health and hold down costs.

Rewarding value instead of volume (episode-based payments): Even with primary care payment reform, high-cost episodes will continue to account for most health spending. Today we pay for all of the inputs in these episodes separately, but if these inputs were considered as a whole then the providers involved would, similarly, work as a team to control costs and maximize quality. In a joint replacement, for example, surgeons, anesthesiologists, hospitals, device manufacturers, rehabilitation therapists, and drug makers all have separate roles and little incentive to worry about each other's costs. Instead, what if the surgeon earned more for meeting high quality standards while also better managing the entire procedure in order to produce lower costs? Many providers are actually doing this today but the savings only accrue to the health insurance plan, not the high-value provider who generates it. In March, 2015, Ohio began working with our state's four largest commercial insurers-Anthem, Aetna, Medical Mutual and UnitedHealthcare-and five Medicaid managed care plans, to set this model in motion for certain high-cost episodes.

The Path Forward:
 Everyone knows that Obamacare must be repealed and replaced with something that actually works in line with America's market-based principles to help Americans be healthy. So, let's not only oppose Obamacare but also put in motion real solutions that will work to improve health care access by holding down costs and help Americans live healthier lives. The Ohio model provides a path forward for the nation: patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals and an end to Obamacare's big government interference.
 Following the principles that have long served America well means returning control of health care choices to patients and returning full control of insurance market regulation to states. In doing so we will help more Americans get and stay healthy in a high-quality and affordable way that sustainably supports our country's long-term economic growth.

Ref: Marco Rubio's campaign site:
 ObamaCare has revealed the painful consequences of placing our faith in big government. Government’s ambitions may be limitless, but its abilities are not. The free market, when allowed to function as intended, has no such limitations. It has an inexhaustible ability to empower our people and meet their needs.
 America needs health care reform that will cut back government’s role and harness the forces of competition to keep health care prices low and spur innovation. That means not just repealing ObamaCare, but replacing it with a market-driven alternative and reforming Medicare and Medicaid for the 21st Century. Rubio would:
 Comment: The following points do sound a bit "high level" to me.

Repeal and Replace ObamaCare

Expand access to affordable, quality health coverage by providing every American with an advanceable, refundable tax credit that can be used to purchase insurance.

Reduce health care costs, promote innovation, and ensure access for the most vulnerable by expanding access to consumer-centered health plans, reforming insurance regulations, and putting protections in place to ensure those with pre-existing health conditions can get access to affordable coverage.

Promote innovation in the Medicaid program by giving states a per-capita block grant, which preserves funding for Medicaid’s unique populations while freeing states from Washington mandates.

Strongly defend traditional Medicare and Medicare Advantage for current seniors.

Strengthen Medicare for future seniors by providing them with choices between a variety of private plans and traditional, fee-for-service Medicare.

Place Medicare on a pathway to fiscal sustainability by promoting market competition in the program. This will ensure it is there for generations of seniors to come.

Donald Trump's campaign site has not included a "health care" position until just recently (early March). There is now a detailed and perhaps very viable plan shown on his site. The key points are:
Ref: Donald Trump's campaign site:

His first point: "Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to." Regarding those who cannot afford to pay for insurance, he says "As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it."

The plan would modify existing laws and allow the sale of health insurance across state lines. "By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up."

The plan would allow health insurance premium payments to be deducted from taxes.

The plan has excellent ideas on Health Savings Accounts, and removes the current serious flaw (the "Use it or lose it" penalty): "Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty."

The plan addresses another serious flaw in our current system, which is that people have no idea what hospital expenses will be until they get their bill. Thus the plan would: "Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."

The plan also addresses the problem of the excessively high cost of drugs. The plan would: "Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers."

Ted Cruz' campaign site does not have an entry for health care under the "Issues" tab, and does not appear to have any information elsewhere on the site.
 However the "cruz.senate.gov" has the contents of the "Health Care Choice Act", introduced by Cruz on March 3, 2015, and co-sponsored by Senators John Barrasso (R-WY), Mike Crapo (R-ID), Marco Rubio (R-FL), and David Vitter (R-LA).
 Ref:www.cruz.senate.gov/?p=press_release&id=2251
 Comment: The following points do sound a bit "high level" to me.

Paying (nondiscriminatory) premium taxes; providing copies of the plan of operation or a feasibility study; written notice of any change in its designation of its primary state and a quarterly financial statement.

Consumer protections such as complying with the secondary state's fraud and abuse and delinquency requirements.

Ref: Hillary Clinton's campaign site:
 The site lists some past efforts on her part, regarding health care:

In 1979, Hillary chaired the Arkansas Rural Health Advisory Committee, which focused on expanding health care access to isolated rural areas of the state.

As first lady. . . she worked with Republicans and Democrats to help create the Children's Health Insurance Program, which now provides health coverage to more than 8 million children.

As senator, she introduced legislation to reduce the cost of health insurance expenses.

Going forward, Hillary will build on these efforts and fight to ensure that the savings from these reforms benefits families-not just insurance companies, drug companies, and large corporations.
 Comment: The following points do sound a bit "high level" to me.

Ref: Bernie Sanders' campaign site:
 Mr Sanders notes that the Affordable Care Act was an important step, but that twenty-nine million Americans today still do not have health insurance and millions more are underinsured.

The Plan:
 Better Coverage
 Bernie's plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie's plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
 What It Means for Patients
 As a patient, all you need to do is go to the doctor and show your insurance card. Bernie's plan means no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges.
 Getting Health Care Spending Under Control
 We outspend all other countries on the planet and our medical spending continues to grow faster than the rate of inflation. Creating a single, public insurance system will go a long way towards getting health care spending under control. The United States has thousands of different health insurance plans, all of which set different reimbursement rates across different networks for providers and procedures resulting in high administrative costs. Two patients with the same condition may get very different care depending on where they live, the health insurance they have and what their insurance covers. A patient may pay different amounts for the same prescription depending solely on where the prescription is filled. Health care providers and patients must navigate this complex and bewildering system wasting precious time and resources.
 By moving to an integrated system, the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively. It will also ensure the federal government can track access to various providers and make smart investments to avoid provider shortages and ensure communities can access the providers they need

Major Savings for Families and Businesses
 Bernie's plan will cost over $6 trillion less than the current health care system over the next ten years.
 The United States currently spends $3 trillion on health care each year-nearly $10,000 per person. Reforming our health care system, simplifying our payment structure and incentivizing new ways to make sure patients are actually getting better health care will generate massive savings. This plan has been estimated to save the American people and businesses over $6 trillion over the next decade.
 The typical middle class family would save over $5,000 under this plan.
 Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer program, amounting to a savings of over $5,800 for that family each year.
 Businesses would save over $9,400 a year in health care costs for the average employee.
 The average annual cost to the employer for a worker with a family who makes $50,000 a year would go from $12,591 to just $3,100.

How Much Will It Cost and How Do We Pay For It?
 This plan has been estimated to cost $1.38 trillion per year. The Plan Would Be Fully Paid For By:

A 6.2 percent income-based health care premium paid by employers

A 2.2 percent income-based premium (tax) paid by households.

Progressive income tax rate increases for higher salaried people:

37 percent on income between $250,000 and $500,000.

43 percent on income between $500,000 and $2 million

48 percent on income between $2 million and $10 million

52 percent on income above $10 million