Presidential Candidates: Where Do They Stand on Health Care?

Updated May 4, 2016

Hot button health care issues dominate many of the presidential contenders’ political platforms.

With the general election looming near, it’s the perfect time to get acquainted with the remaining candidates' stances on important health care themes, including the Affordable Care Act (ACA), Medicare, Medicaid, prescription drug costs, childhood vaccinations, and Planned Parenthood funding.

At this point, every remaining candidate has solidified his or her health care platform. Here's what we know:

Click on a candidate's face to jump to their platform.

Democrats

Hillary Clinton, Secretary of State, Former First Lady

Clinton made waves in the pharmaceutical industry by denouncing the Daraprim price increase via Twitter.

Price gouging like this in the specialty drug market is outrageous. Tomorrow I'll lay out a plan to take it on. -H https://t.co/9Z0Aw7aI6h

— Hillary Clinton (@HillaryClinton) September 21, 2015

Clinton’s proposal aims to lower drug costs by reducing pharmaceutical industry tax breaks and mandating certain levels of research spending, Bloomberg reported.

Specific provisions of her plan include:

• Enacting a $250 per month ($3000 per year) cap on patients’ out-of-pocket prescription drug spending.
• Reducing the sales exclusivity period for biotech drugs to 7 years from the current 12 years.
• Banning pharmaceutical companies from writing off drug advertising spending as a business expense.
• Allowing Medicare to negotiate drug prices with manufacturers—a right already afforded to both Medicaid and the US Department of Veterans Affairs.

Clinton has voiced concerns about the lack of transparency in the pharmaceutical industry before.

“There have been some really positive efforts, but the cost has gone up, the amount of our GDP has gone up, and the outcomes are not commensurate with the amount of money that we’re spending because we have a disorganized system, we don’t have enough transparency about cost,” Clinton said during her keynote address at the 2013 NACDS Total Store Expo. “One of the things that is happening under the Affordable Care Act, which I fully support, is putting out more information about what the difference in cost is between certain surgical procedures in different hospital settings. Because...information is essential for us to make the right choices. ”

Clinton was also an active participant in health care reform discussions while her husband Bill Clinton served as President during the 1990s.

Asked what she thought the health care system would look like today if health reform had passed when it was initially introduced during the Clinton Administration, she responded that it was difficult to say.

During the first Democratic presidential debate, Clinton along with Sanders said that immigrants should be allowed to use Healthcare.gov to shop around for insurance plans, yet conceded that they should not receive a federal subsidy to finance their premiums.

Then, during the second Democratic presidential debate, Clinton said it is "outrageous" that Medicare is unable to negotiate with drug manufacturers for lower prices.

"We're going to have to redo the way the prescription drug industry does business…In fact, American consumers pay the highest prices in the world for drugs,” Clinton said. “We have to go after price gouging and monopolistic practices and get Medicare the authority to negotiate."

At the beginning of November 2015, just before Veterans Day, Clinton unveiled her plan for veterans' health care, which includes a proposal for the government to contract with private providers for a range of health services in an effort to improve wait times.

At the end of the month, Clinton announced a tax refundable tax credit proposal to help those with the out-of-pocket health expenses. The credit would be up to $5000 for a family and up to $2500 for an individual, and people would be eligible if their expenses exceeded 5% of their income. It would be funded by a tax increase on the wealthy and by "demanding" rebates from drug manufacturers.

On her campaign website, Clinton added that she plans to revive the "public option" component of the health care law, which was eliminated before passage after a group of moderate Democrats sought to minimize the role of government in providing health care.

Instead of attempting to push this public option through Congress, Clinton will utilize the existing flexibility of the ACA "to empower states to establish a public option choice."

Clinton also pledges to "protect women's access to reproductive health care, including contraception and safe, legal abortion" and to "defend Planned Parenthood."

Bernie Sanders, Senator from Vermont

Bernie Sanders has been very active in Congress on the issues of prescription benefits and drug pricing regulations.

Sanders introduced the Medicaid Generic Drug Price Fairness Act in the Senate in 2014, and then again in 2015. This proposed legislation would require drug manufacturers to pay a rebate to Medicaid when their generic prices increase at a rate that outpaces inflation.

He noted that the idea of shielding both pharmacies and patients from lagging medication reimbursement rates and unchecked costs is not unprecedented in US health policy. Under the proposed act, the same price protections that already apply to brand-name drugs would extend to generic medications purchased under Medicaid.

He claims the law would save $1 billion in taxpayer funds.

Sanders, along with Representative Elijah Cummings, have called on pharmaceutical companies that appear to be price gouging to testify before Congress and explain the reasons behind their drug price hikes.

During the first Democratic presidential debate, Sanders along with Clinton said that immigrants should be allowed to use Healthcare.gov to shop around for insurance plans, yet conceded that they should not receive a federal subsidy to finance their premiums.

Then, during the second Democratic presidential debate, Sanders accused the pharmaceutical industry of "ripping off the American people every single day," and touted himself as the "first member of Congress to take Americans over the Canadian border to buy breast cancer drugs for one-tenth the price they were paying in the United States."

At the end of November 2015, Sanders officially released his "repeal and replace" health plan—colloquially referred to as "BernieCare." It is a single-payer system loosely modeled on how most of Western Europe and Canada finance their health-care systems.

Insurance premiums, deductibles, and co-pays, including those for brand-name prescriptions, would all be eliminated under BernieCare. The role of health insurers would be reduced to selling supplemental coverage for services not covered under the single-payer plan.

His "Medicare for All" plan would be funded by a 2.2% "health care income tax," with higher earners paying a higher rate, as well as a 6.2% income-based premium paid by employers and capital gains and dividends tax that equals an individual's income tax rate.

Initially this single-payer plan would be focused on slowing the growth in health care spending by placing hospitals on budgets, negotiating drug prices with pharmaceutical companies, and other cost-cutting measures.

Medicare, Medicaid, and the Children's Health Insurance Program would all be absorbed into BernieCare.

States would be afforded the right to decide whether or not illegal immigrants would be covered in their state, but would not be allowed to refuse the system—as many Republican-controlled states did under the ACA by not enacting Medicaid expansion.

In Sanders' "Agenda for America: 12 Steps Forward," he refers to health care as a human right.

Republicans

Donald Trump, CEO of The Trump Organization

As the sole remaining Republican candidate, the real estate mogul's health care platform has been fully sussed out.

During his candidacy announcement speech, Trump called for the ACA to be repealed and “replaced with something much better for everybody…and much less expensive.”On his campaign website, Trump refers to the ACA as an "incredible economic burden" and asserts that free market principles are the true path to broadened health care access.

"On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” his health issue webpage reads.

At the Conservative Political Action Conference (CPAC) in 2013, Trump said that funding for entitlement programs should not be cut at all; rather, he said the solution lies in “building a great economy” that can sustain the cost of keeping the programs.

“Medicare, Medicaid, Social Security. They all become affordable when we become a wealthy country again,” Trump said.

He also calls for price transparency from all health providers, although he points to physicians, clinics, and hospitals in particular.

With respect to prescription drugs, Trump promises to remove any barriers to entry into free markets for drug manufacturers that offer "safe, reliable, and cheaper products."

"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," he said.

He also spoke at length about childhood vaccinations during the second Republican presidential debate.

“I’m in favor of vaccines. Do them over a longer period of time, same amount,” he said, claiming that this would have a “big impact” on autism.

He said he believes that autism has become an epidemic, with an increase in diagnoses over the last couple of decades.

During CNN's Republican town hall in February 2016, Anderson Cooper asked about Trump’s plan for patients with pre-existing conditions if the ACA and individual mandate were to be eliminated. Trump responded that there should be a "backstop" for such patients.

The only substantial way Trump's health plan differs from Republican health care orthodoxy is that he favors allowing Medicare to negotiate prescription drug prices with pharmaceutical companies.