Transcript Student Visit Day Department of Health Services Administration

Forum on the
Future of Health Care:
How the Presidential Candidates’
Positions Will Impact our Health
Care System
April 25, 2016
University of Maryland
School of Public Health
Welcome!
Luisa Franzini, PhD
Chair and Professor
Health Services Administration
The Presidential Candidates’
Health Care Platforms
Dylan Roby, PhD
Assistant Professor
Health Services Administration
The Platforms
• The Maryland Primary for both parties is
tomorrow!
• All Candidates propose some level of change
– Range of ideas from Single Payer reforms to
incremental changes to address pharmaceutical
and insurance premium cost growth
• Some of the proposed plans lack detail
– Signal direction for policy interests, but would face
opposition from many stakeholders
Democratic Candidates
Secretary Hillary Clinton
• Slow out-of-pocket cost growth throughout system
– Deductibles and cost sharing
– Tax credits of up to $5,000 for those with premiums over 5% of income
• Incremental changes to ACA Health Insurance Marketplace Plans
– Prescription drug spending caps ($250/month)
– Cap family premium spending to 8.5% of income
– More outreach and enrollment funding
– Undocumented can buy on Exchange with their own money
– State “public options” via 1332 waivers or other mechanisms
• Allow states to get 100% matching for first three years of Medicaid expansion
• Reproductive Health
• Access for rural populations via Telehealth
• Pharmaceutical Oversight: Require minimum R&D investment and eliminate
ability to deduct marketing costs from taxes
Senator Bernie Sanders
• Comprehensive, Universal Health Coverage through
“Medicare-for-All” Plan
– Replace private insurance with “single payer” Medicare-like program
• Benefit package would be expanded to include vision, dental, long-term
care and there would be no cost sharing
• Funded via combination of payroll taxes, high-income surcharge, and
income tax increase
• Workers would no longer pay for share of employer-based premiums, and
employers would no longer offer coverage
• In the interim, encourage states to expand Medicaid
• Investment in Community Health Centers
• Prescription drug costs
– Medicaid rebates for generics in case of price increases
– Re-importation of drugs
Republican Candidates
Senator Ted Cruz
• Focus on repealing ACA via legislation
– Says he would not use administrative authority
– Remove employer and individual mandates
• Nationwide Health Insurance Marketplace
– Allow purchase across states lines, while requiring
insurers to honor benefits from home state
– Make “Catastrophic plans” more available
– Not clear about “pre-existing” conditions
• Expand Health Savings Accounts
• De-link health insurance from employment
Governor John Kasich
• Repeal and replace the ACA
– Seems to support Medicaid and individual insurance
market competition and “guaranteed issue”
– Does not like employer mandate or government cost
control authority and alliances
• Export developments from Ohio:
– Patient-Centered primary care with shared savings in
commercial insurance and Medicaid program
– Episode-based payments
• Does not explicitly mention purchase of insurance
across states lines, health savings accounts, or
Medicaid block grants
Donald Trump
• Repeal and replace the ACA
– Strong opposition to the individual mandate
– Has signaled interest in comprehensive, universal coverage
based on free market principles
• Like Cruz, wants insurance to be sold across state lines
with benefits aligned to “home” state of purchaser
• Tax deduction for health insurance premiums
• Work with states on “basic” Medicaid options
– Via state block grants
• Health Savings Accounts
• Price transparency
• Re-importation of pharmaceuticals and price
negotiation
Our Panelists
Eli Tomar, JD, MPH
Associate
Akin Gump Strauss Hauer &
Feld
Areas of Expertise:
• Policy, Legislation, and
Regulation
• Federal health care reform
Education:
University of Maryland College
Park (BA)
UCLA (JD & MPH)
Bruce Lesley
President
First Focus
Areas of Expertise:
• Children’s Health
• Medicaid and CHIP
• Federal and State Health
Policy
Education:
• University of Maryland
University College (BA)
George Escobar
Director of Health and
Human Services
CASA de Maryland
Education:
• UCLA (BA)
Areas of Expertise:
• Immigrant Health Care
• Medicaid and Individual Insurance Enrollment
• Access to care for the undocumented
Panelist Reflections on Health Care
Reform in the Primaries
Questions from the Audience
Thank you!
Now go Vote!
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@UMDPublicHealth