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THE FUTURE of HEALTH CARE REFORM What Changes Will November’S Election Bring?

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THE FUTURE of HEALTH CARE REFORM What Changes Will November’S Election Bring? KHI.ORG Informing Policy. Improving Health. THE FUTURE OF HEALTH CARE REFORM What changes will November’s election bring? Next month, Americans will be casting challenges, some going all the way to the U.S. their votes for a new president and many Supreme Court. With a new leader in the White members of Congress, which will likely House and the potential for a change in control result in new health care policies for of one or both chambers of Congress, what will the country. President Barack Obama’s be the future of health care in America? ISSUE BRIEF signature health care legislation, the Affordable Care Act (ACA—also known as Obamacare), has been in place since 2010 Three Health Reform and has largely been implemented over Proposals the past six years. The law has resulted Democratic presidential candidate Hillary in widespread changes to health care in Clinton has pledged to defend and expand on America, resulting in nearly 13 million fewer the ACA, while Republican candidate Donald adults (age 18–64) without health insurance Trump has stated his intent to repeal the ACA if since 2013, widespread innovation and he becomes the next president. Within the past experimentation in the delivery of health few months, both of the candidates and House care, and upheaval and uncertainty in the regulation of health insurance and the Republicans have released plans laying out their insurance markets. priorities for health care reform for 2017 and beyond. A review of these plans makes it clear Since its enactment, some Republican that regardless of who is in control of the White members of Congress have attempted to House and Congress beginning in 2017, health repeal the law more than 50 times, and care and policy in the United States will continue the law has been subject to multiple legal to evolve. The future is anything but certain. OCTOBER 2016 KHI/16-11 Donald Trump Hillary Clinton In March 2016, while running for Clinton has stated she intends the Republican nomination, Trump to “strengthen, improve and released a brief, seven-point health build on” the ACA but has care reform plan to: also released her own nine- point health care plan, entitled • Repeal Obamacare and eliminate the individual Universal, Quality, Affordable Health Care for mandate; Everyone. In her plan, she proposes to: • Allow insurance companies to sell health insurance across state lines; • Defend and expand the ACA; • Allow individuals to fully deduct their health insurance • Bring down out-of-pocket costs, such as premium payments from their taxes; copays and deductibles for consumers; • Encourage and support the use of health savings • Reduce the cost of prescription drugs; accounts by individuals to cover some health care • Protect consumers from unjustified costs; prescription drug price increases; • Require price transparency from all health care • Incentivize states to expand Medicaid; providers, including doctors and hospitals; • Expand access to affordable health care to • Make block grants to states for their Medicaid families, regardless of immigration status; programs; and • Remove barriers to entry into the U.S. drug market for • Expand access to rural Americans by overseas companies. exploring ways to make more health care providers eligible for telehealth reimbursement under Medicare and other Republican Members of the programs; U.S. House of Representatives • Ensure that all women have access to A few months later, on June 22, 2016, Speaker of the reproductive health care; and House Paul Ryan announced the release of the proposed replacement plan for the ACA developed by House • Double funding for community health centers Republicans (the “GOP Plan”). The 37-page report, entitled and expand the health care workforce. A Better Way, Our Vision For A Confident America, Health Care, is built on five key principles: The Affordable Care Act • Repealing Obamacare; As noted above, both Trump and House • Providing all Americans with more choices, lower Republicans have stated that repealing the costs, and greater flexibility through greater ACA is their first priority. Trump has specifically competition among health insurance companies; emphasized elimination of the individual mandate, a key part of the ACA and the subject of one of • Protecting the nation’s most vulnerable citizens, the legal challenges that was addressed by the U.S. including individuals with pre-existing health Supreme Court in 2012. conditions and low-income families; Clinton has pledged to defend and expand • Spurring innovation in health care by building on the the ACA, and is promoting the creation of a 21st Century Cures Act passed by the House in 2015, “public-option” insurance plan, a concept she which supports advancements in medical cures and has supported since 2008. A public-option plan treatments; and would be a government-run insurance plan that • Protecting and preserving Medicare by financially would offer coverage through the ACA’s online strengthening the program and slowly phasing in marketplaces, in direct competition with private improvements for future generations. insurers. 2 October 2016 The Future of Health Care Reform Prescription Drug Costs but have not yet enrolled, and will work to make enrollment in both Medicaid and ACA coverage To address the rising cost of prescription drugs, both easier. Clinton and Trump are proposing to allow consumers to import prescription drugs for their personal use Clinton also wants to expand access for rural from foreign nations that have safety and quality Americans by making more health care providers standards similar to the U.S. eligible for reimbursement for telehealth services under Medicare and other programs, including Clinton is also proposing to allow Medicare to federally qualified health centers (FQHCs) and rural demand higher rebates and negotiate drug prices health clinics. with drug companies, require pharmaceutical companies that benefit from federal support to invest a “sufficient amount of their revenue in research Medicare and development,” and clear out the Food and Drug Administration’s (FDA) backlog of generic drug House Republicans are proposing a number of approvals, reducing exclusivity periods for biologic changes to Medicare. Assuming a repeal of the ACA, drugs, and expediting review of applications for certain changes in federal payments to Medicare biosimilar drugs. She also proposes to create a federal Advantage (MA) plans (the private alternative to oversight group that would be charged with reviewing traditional Medicare) would be reversed to their pre- proposed price increases for existing drugs and ACA status, both the Independent Payment Advisory imposing penalties for unjustified price increases. Board and the Center for Medicare & Medicaid Innovation would be eliminated, and the ban on expansion of physician-owned hospitals would be Coverage and Access for Vulnerable lifted. Populations The GOP Plan also recommends giving MA insurers For individuals who are unable to afford insurance more flexibility to create value-based plans, reducing coverage, Trump is proposing that individuals be or phasing-out first dollar coverage in Medicare allowed to fully deduct the amount of their monthly supplement (Medigap) policies beginning in 2020, health insurance premiums from their taxes. He has and combining Medicare Parts A and B to create a also stated that the country needs to look at Medicaid unified, single deductible and 20 percent uniform program options and work with states to ensure that cost-sharing requirement. It also includes repealing individuals who want coverage can have it. the fiscal year 2018 and 2019 disproportionate Clinton has stated she will work with governors to share hospital (DSH) cuts (also the 2018–2020 expand Medicaid in every state and also expand Medicaid DSH cuts); creating a new Medicare access to health care for families, regardless of their Compare website to post reports comparing MA and immigration status, by allowing them to purchase traditional fee-for-service (FFS) Medicare on a core health insurance on the ACA marketplaces. She also set of quality measures, and gradually increasing proposes to launch a national campaign to enroll the Medicare retirement age beginning in 2020 to people in ACA coverage who are already eligible correspond to the eligibility age for Social Security. Both Hillary Clinton and Donald Trump propose allowing consumers to import prescription drugs from foreign countries that have similar quality and safety standards as the U.S. The Future of Health Care Reform October 2016 3 Finally, beginning in 2024, House Republicans in the enhanced match rate for the expansion propose to convert the Medicare system to a population but would be able to spend the funds competitive, market-based model, in which seniors across populations. The Children’s Health Insurance would be given a choice of private plans on a Program (CHIP) match rate would return to its pre- Medicare Exchange to compete with the traditional ACA levels. FFS program, and would be provided with premium support payments to pay for or offset the premium This option would account for changes in a state’s of the plan chosen, depending on the plan’s cost. volume and mix of Medicaid beneficiaries, and is similar to one of the Medicaid reform approaches Clinton is opposed to the GOP Plan to privatize outlined by Governor Sam Brownback in 2011 Medicare but is proposing to expand the Medicare in correspondence with then-Health and Human program by allowing people age 55 and older to opt Services Secretary Kathleen Sebelius. It also shares in, while protecting the traditional program. similarities with an approach President Bill Clinton proposed in the mid-1990s as an alternative to a Medicaid block grant formula then favored by the Republican Congress. Trump has proposed that federal funding for Medicaid be provided in the form of block grants to Under the block grant approach outlined in the GOP states to operate their programs. Similarly, the House Plan, states that opt out of per capita allotment Republican plan includes a description of two options funding could automatically receive a block grant for funding Medicaid: a “per capita allotment” or a to fund their Medicaid program.
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