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

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