The Pulse: Clinton And Trump, What About Health Care?

Sep 29, 2016

Credit National Cancer Institute

The presidential candidates debated for the first time Monday night, and health care barely got a mention. Health care hasn’t exactly been in the spotlight throughout this presidential campaign. 

This week on The Pulse, Rhode Island Public Radio health care reporter Kristin Gourlay looks at why that might be. She joins News Director Elisabeth Harrison. 


ELISABETH: Kristin, why do you think health care got short shrift in the first presidential debate?

KRISTIN: Well, the candidates have positions on health care issues. But they don’t spend a lot of time talking about them – the news recently has been so dominated by national security, the economy, etc. That might be exactly what they should be talking about – I’m not a political analyst – but I can tell you the next president will have his or her work cut out when it comes to addressing some big health care issues.

ELISABETH: OK – what’s first on your list?

KRISTIN: Cost. The Affordable Care Act was supposed to extend insurance coverage to more people and bring down costs. It’s done the first – that’s a fact. But the second promise has been slower to come true. Rhode Islanders – individuals and businesses – continue to see not only increases in their monthly premiums, but increases in the deductibles and out-of-pocket costs. Those are what you pay before your insurance kicks in, or in addition to your monthly premium. And that’s a trend that most people are seeing across the country.

ELISABETH: For this coming year, the increases -- at least in Rhode Island – seemed pretty small.

KRISTIN: True, but year after year they add up. And that’s despite the overall slowing of the growth in health care costs nationwide. I’d like to hear a presidential candidate address one of the biggest drivers of those costs: pharmaceuticals. The federal government could do some things to address that, like allowing more negotiation of drug prices.

ELISABETH: So, this may come up in one of the next two debates, but Hillary Clinton has put out a plan for lowering drug costs. She would allow Medicare to negotiate drug prices – which it can’t now. She’d take away tax breaks for drug company consumer ads. And there’s a list of other initiatives. Trump doesn’t offer any specifics on drug prices.

KRISTIN: Right. He has said that he would repeal the Affordable Care Act, which is President Obama’s signature piece of legislation on health care. Democrats see it as a big accomplishment, but Republicans are big critics of this legislation. Trump’s position statement on health care on his web site outlines what he sees as major problems. It seems he’d address cost and quality by letting Americans buy the best private insurance they can afford with a health savings account. That’s an account that lets you set aside money for health care costs and you don’t have to pay income taxes on that money.

ELISABETH: Kristin, what other major health issues do you think the candidates have largely ignored during this campaign?

KRISTIN:  I’d like to hear a candidate talk about how he or she could make it easier to respond to public health emergencies, like Zika, or Ebola.

ELISABETH: Are you referring to funding? There’s been some movement on the Zika funding bill.

KRISTIN: That’s right – but the point is we’re dependent on Congress for the funding public health officials and communities need to respond to these emergencies. I wonder how the commander in chief might make the process a bit more predictable or sustainable, like setting up an emergency fund, or reserving the right to direct funds to states in emergencies like this. Because we’re going to see more of these types of issues as climate change unfolds, I think. The Centers for Disease Control and Prevention can only do so much. Additional funding could help speed the development of a vaccine or direct resources to other countries to help their Zika prevention efforts.

ELISABETH: This may be a tall order – to make Congress act. Are there items on your list that wouldn’t need Congressional action?

KRISTIN: Yes - number three: I’d love to hear the candidates pay more attention to our aging and disabled population. Baby boomers are rapidly aging, and we don’t have a great plan for long term care in this country. It’s expensive! And Medicare doesn’t pay for it. Sure, there are great nursing homes, great caregivers, all of that – if you have money. And once you run out, you rely on Medicaid or family. That’s not a sustainable solution, given our demographics. I think attention to the problem from our most visible leaders would help focus a lot more minds on this problem. People are trying to tackle it, but it’s in bits and pieces. In Rhode Island, we’re trying to shift more people away from more costly nursing home settings and into less expensive community settings, like their own apartments or group homes. But there’s not enough affordable housing for seniors.

ELISABETH: And Rhode Island has one of the highest percentages of older people in the nation, so that issue hits home here. Kristin Gourlay, before you go, can you just give us a refresher on few of the key differences between the candidates on health care issues?

KRISTIN: Sure. I’ll just give you the broad brush. Let’s start with Donald Trump. He says he would repeal the affordable care act and give everyone something called a health savings account – that’s pre-tax money to spend on your health care. Hillary Clinton would keep the ACA and strengthen it. Clinton would expand access to health insurance coverage through the online exchanges to people, regardless of their immigration status. Trump is definitely against that. He says he would also give states more flexibility with how they manage their Medicaid dollars, and let people buy insurance across state lines. Clinton would give states that haven’t yet more incentives to expand Medicaid. And she’d double funding to community health centers.

ELISABETH: There’s so much more to cover when it comes to the candidates’ positions on health care but we’ll have to leave it there. Thanks, Kristin.

KRISTIN: You’re welcome.