Whenever the topic of healthcare has come up during the 2016 presidential election, candidates have largely focused on the Affordable Care Act (ACA), popularly known as Obamacare.
Of course, that’s not the only aspect of healthcare. But it touches on several key issues affecting the health of the country — such as the uninsured and high healthcare costs.
As the primary season gets into full swing, here is a breakdown of the top candidates’ stances on healthcare.
More detailed information can be found on their campaign websites. Other websites, such as Ballotpedia track what the candidates are saying in debates and in the news.
Affordable Care Act
In general, the candidate’s discussions about the ACA fall along party lines.
“We’re mostly hearing that the Democrats running would be either trying to continue the Affordable Care Act or expand upon it,” Dr. Andrew Bindman, a professor of medicine, health policy, epidemiology, and biostatistics, at the University of California San Francisco, told Healthline. “Whereas the Republicans are mostly ticking the box of suggesting they want to repeal it.”
Hillary Clinton (Dem.): Clinton has vowed to continue to block Republican efforts to repeal the ACA. She will keep it intact but work to increase the number of people with affordable coverage. As of the second quarter of 2015, 9.2 percent of Americans were still uninsured. Under Clinton’s plan, insurance companies could maintain preferred networks of doctors and other providers.
Bernie Sanders (Dem.): Sanders voted for the ACA, but in the second Democratic primary debate he said, “"I believe we've got to go further.” His “Medicare for All” plan would provide universal coverage through an insurance program administered by the federal government. In addition, people would be able to visit any doctor, rather than a limited network of providers.
Ted Cruz (Rep.): Cruz has been a staunch opponent of the ACA and has frequently called for the repeal of “every word of Obamacare.” He has not put forth a detailed healthcare plan but has said he will “pass commonsense health insurance reform to make health insurance personal and portable and affordable.” His approach would include delinking health insurance from a person’s job and increasing the use of health savings accounts.
Donald Trump (Rep.): In 2013, Trump called the ACA "a total disaster.” However, he has suggested that he supports universal health care. But his campaign has also stated that he favors a free-market system that gives power over health insurance back to the states.
High Cost of Healthcare
In addition to the number of uninsured in the United States, the rising cost of prescription drugs and overall healthcare is also serious problem for the country.
“That’s a huge issue. Our population is aging and health care costs are a big part of our economy,” Bindman said. “We need to know whether it is squeezing out other things that we want to be investing our resources in.”
Clinton: Clinton’s plan would work toward reducing the out-of-pocket costs for healthcare. This includes insurance copayments and deductibles. She would also tackle the high costs of prescription drugs by encouraging the production of lower-cost generics, allowing Americans to import drugs from other countries, and limiting the monthly out-of-pocket drug costs for patients with chronic or other serious health conditions.
Sanders: Under Sanders’ plan, every aspect of healthcare would be covered, including inpatient and outpatient care, mental health services, prescription drugs and diagnostic testing. His plan would also eliminate copayments and deductibles. People over a certain income threshold would still have to pay an insurance premium. For a family of four making $50,000, this would be $466 a year, much lower than the current average of $6,408. Sanders said taxes will have to be raised to pay for the expanded services.
Cruz: Cruz often blames the ACA for high insurance premiums. He favors a free-market approach to lowering healthcare costs, with expanded competition in the health care system. This includes allowing people to purchase insurance across state lines and increasing the use of health savings accounts.
Trump: Trump also favors a free-market approach to keeping insurance plans affordable. As with Cruz’s plan, people would be allowed to purchase insurance across state lines rather than only in their own state. Trump also believes that this approach would break insurance company monopolies.
What’s Not Being Mentioned?
While many people think of health insurance whenever the ACA is mentioned, there’s a lot more to healthcare in the United States. And a lot more that could be discussed.
One of the overlooked aspects of healthcare is the public health system, which also plays an important role in keeping people informed, as well as healthy.
“This recent outbreak of the Zika virus is a reminder to us about how do we keep ourselves prepared to be able to address public health challenges,” Bindman said.
There’s also the recent consolidation of healthcare providers into fewer, but larger, groups.
“That may have some good aspects to it,” Bindman said. There are also “some concerns about whether some of the benefits of competition might be threatened in some communities.”
With economic and foreign policy issues taking center stage, the ACA may not be the main focus of the candidates. But it could still be distracting the conversation from these other important healthcare issues.
“The unfortunate part of the election coverage so far has been that it pretty much doesn’t get much deeper than ‘The ACA—am I for it or against it’ kind of tick box,” Bindman said.