Now that the 2016 presidential election has narrowed to Democrat Hillary Clinton and Republican Donald Trump, it is only fitting that their positions on health care are more closely examined. While both candidates have supported the idea of expanding health coverage to more Americans, they propose different mechanisms to achieve this. Trump has announced that he would repeal the Affordable Care Act in favor of a replacement plan. He would also transform Medicaid into a block grant for states, allocating a set amount each year.
On the other side of the aisle, Clinton would not only maintain the current healthcare reforms, popularly known as Obamacare, but plans to dramatically expand coverage in a number of ways. Among the components of her health plan are expanded tax credits, greater incentives for states to expand Medicaid, access for undocumented residents, outcome-based repayment and expanded access for rural Americans. In essence, Clinton would try to increase the 90 percent of Americans covered under the current system to include the entire nation.
However, what has gone largely unnoticed by the public is a startling proposal to increase the scope of Medicare. In its current form Medicare is available to Americans starting at age 65, but under Clinton's new proposal, Americans as young as 50 could buy into the program. She has argued that this expansion would offset current costs to the federal government because younger enrollees have fewer health problems and would cost less to cover. If implemented this public option would be a subtle expansion of the country's largest single payer system.
Her ambitious plan should spark a debate with her political opponent as well as with American voters. In a recent Kaiser Family Foundation, health care was the most important issue to Democrats with 43 percent labeling the issue as "extremely important to their vote." Independents and Republicans ranked it fourth in voting issue importance, with 30 percent and 37 percent, respectively, considering it extremely important.
This facet of her health plan is likely an artifact of her primary struggle with fellow Democrat Bernie Sanders, who supported universal health coverage. In fact, the public option was considered by the Obama administration while developing its reforms, but was ultimately scuttled to help make the policy more palatable to centrist Democrats.
There are currently 13 million Americans between the ages of 50 and 65 without health insurance or insured through the Obamacare insurance marketplaces. A report from Avalere suggests that for many of the uninsured in this population, a Medicare buy-in may be financially unfeasible. For those already insured, the Medicare option may be less appealing than private insurance because of limitations that the federal program imposes on enrollees.
If Mrs. Clinton is elected and pushes through this major Medicare expansion, it could be the beginning of a way to introduce universal health coverage to the U.S. In order to make Medicare an attractive option, she may need to attach financial incentives like tax credits. Conceivably, President Clinton or her successors could incrementally grow the program until, eventually, the entire country is enrolled in it.
Article written by:
Robert Moghim, M.D.
CEO, Health Carousel Locum Tenens