Presidential contender Jeb Bush has said that the Affordable Care Act doesn’t work and is “flawed to its core.” He supports improving the quality of health care and lowering costs by applying “free market principles.” Bush’s official website describes a three-part plan to repeal the Affordable Care Act and replace it with legislation that he believes would:

  • Promote innovation in health care.
  • Lower costs and enable portable, secure coverage for all Americans.
  • Take health care control out of Washington and return it to the states.

The Jeb Bush agenda for “innovation” is essentially a plan to deregulate the health care system at the federal level. It would rely on insurance companies and health care providers to “innovate” but would not establish any health care objectives to be achieved. Bush would promote the health insurance market through a tax credit for health insurance policies that cover “high-cost medical events.” It is unclear whether his tax credit would be available for coverage of routine care or treatment of chronic conditions. The plan appears to shift the burden of health care costs onto individuals (assuming they can afford care) and reduce the incentive for employer-supported health insurance. The plan would provide “capped federal funding” to states, but make the states responsible to “enable access to affordable catastrophic plans,” to guarantee “continuous coverage” for individuals with pre-existing conditions, to reduce medical liability and to strengthen the health care “safety net.”

Hillary Clinton, in contrast, defends the Affordable Care Act. According to the Clinton website, her plan would seek to lower out-of-pocket costs for copays and deductibles, lower the cost of prescription drugs, and improve the health care delivery system.

The Clinton approach to health care seems cautious. It is a list of appealing policy objectives, but it is short on specifics.

Bernie Sanders voted for the Affordable Care Act, but he believes that it does not go far enough to provide universal, high-quality health care in a cost-effective way. He supports moving toward a single-payer “Medicare-for-all” system.  The Sanders website focuses the health care issue on lowering the cost of prescription drugs. Sanders supports policies that would:

  • Require Medicare to use its bargaining power to negotiate with the prescription drug companies for better prices.
  • Allow individuals, pharmacists and wholesalers to import prescription drugs from licensed Canadian pharmacies.
  • Prohibit the United States from agreeing to provisions in international trade deals that would raise drug prices in the United States.
  • Restore discounts for low-income seniors.
  • Prohibit anti-competitive “pay-for-delay” deals between brand and generic drug makers.
  • Enact stronger penalties for drug companies convicted of fraud.
  • Require drug companies to publically report information that affects drug pricing, including the total expenditures on research and development and clinical trials, as well as the portion of their drug development expenses offset by tax credits or paid for by federal grants.

Sanders deserves credit for putting out a package of specific proposals and for focusing on a critical component of health care—prescription drug costs—where the ACA falls short.

Health care is one of the six focus issues that the next chapter is following during the presidential campaign.

On health care:

Do you support the ACA and efforts to improve or expand it?

TNC’s take: The next chapter believes that the Affordable Care Act was important and historic legislation. The ACA took a huge step forward toward universal health care in the United States—a reform that has been long overdue. Additional reforms or amendments will be needed to improve or expand the ACA and to make health care more accessible, particularly for low-income families.

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