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Quick Takes on the Democratic Presidential Candidates’ Health Care Plans

Molyneux, Jacob

AJN, American Journal of Nursing: April 2016 - Volume 116 - Issue 4 - p 23
doi: 10.1097/01.NAJ.0000482135.66682.cb
Policy and Politics

Clinton wants to build on the ACA's gains; Sanders says it's time for the next big step

Senior Editor

Editor's note: Throughout the year, we will be providing readers with information from the campaigns of both political parties relating to health care and health care coverage. Here is a snapshot of the health care platforms of the two democratic front-runners, Bernie Sanders and Hillary Clinton.

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In his health care platform, Bernie Sanders, a U.S. senator from Vermont, proposes a “federally administered single-payer” program, Medicare for All, which would cover the “entire continuum of health care” for every American (see Senator Sanders, who was officially endorsed by National Nurses United in August 2015, acknowledges significant gains in coverage (17 million more insured) that have resulted from the Affordable Care Act (ACA). But he believes his plan is the best way to address continuing gaps in coverage (29 million still uninsured) and the increasing costs to consumers from high deductibles, premiums, and copays. Medicare for All would “separate health insurance coverage from employment,” thus addressing the perennial insecurity of job-based coverage.

How would this plan be paid for? According to Sanders, there would be a 2.2% tax increase for all Americans (more than offset, in his analysis, by monthly savings in health care costs), a corporate tax of 6.2%, and higher tax rates with fewer deductions for American households making over $250,000 a year. In addition, Sanders would seek to cut health care costs by negotiating drug prices and eliminating many of the expenses associated with insurance paperwork.

Could Sanders, if elected, make this plan a reality? The opposition from a Congress already opposed to the ACA would be strong, not to mention the pushback from pharmaceutical and insurance lobbies, among others. If stymied, Sanders might end up pursuing aims similar to those of Hillary Clinton, working to improve the ACA in terms of access, quality, and cost. One effect of the Sanders plan, whatever the outcome of the election process, has been to shine a spotlight on continuing inequalities in access to quality, affordable health care in the United States.

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Long a supporter of health care reform and currently an enthusiastic supporter of the ACA, Hillary Clinton has proposed a platform (see that, along with defending the ACA from ongoing Republican attempts to undermine or repeal it, seeks to improve on the ACA's gains by reducing out-of-pocket costs to consumers, such as copays and deductibles; negotiating drug costs; and expanding access to groups who remain uninsured or underinsured. The ACA has already focused attention on measuring and rewarding quality in health care delivery. Clinton would continue to build on those efforts to tie reimbursement to “value and quality,” efforts that thus far have had real successes but still need refining in the face of vigorous criticism of certain metrics. Another core tenet foregrounded in the Clinton plan is the defense of women's reproductive rights.—Jacob Molyneux, senior editor

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