Clinton's and Trump's Positions on Major Healthcare Issues

As the presidential election nears, the positions of the two major candidates on healthcare have received more attention. Both Clinton and Trump have their healthcare positions listed on their websites (1,2). Below is a table listing their positions from their websites and occasionally other sources followed by a brief discussion of each of the issues. 

Table 1. Presidential candidate positions on healthcare issues. A questions mark denotes an unclear position.

Affordable Care Act (ACA, Obamacare)

This is a major difference between Clinton and Trump. Clinton favors its retention (1). Trump favors its repeal (2).

Access to reproductive health

Clinton supports reproductive preventive care, affordable contraception, and safe and legal abortion (1). Trump's position is unclear. He currently is pro-life but would not use Federal funds for abortion (2). Federal funding for abortions us is prohibited by law (3).

Allow importing drugs to reduce costs

Both candidates favor importation of prescription drugs to reduce prices (1,2).

Block-grant Medicaid to the states

Trump block-grants asserting that "the state governments know their people best and can manage the administration of Medicaid far better without federal overhead" (2). This idea is not new with Congressional Republicans pushing for block-granting Medicaid at least since the 1990s (4) Clinton's position is unclear (1).

Coverage of poor

Both candidates favor universal healthcare including the poor (1,2).

Healthcare for illegal immigrants

Clinton favors extending healthcare to families regardless of immigration status by allowing families to buy health insurance on the health exchanges (1). Trump's website notes that providing healthcare to illegal immigrants costs us some $11 billion annually and he favors strict enforcement of the current immigration laws (2).

Healthcare savings accounts

Trump favors savings accounts which are permitted under the ACA but with restrictions (2,5). Clinton's position is unclear.

Increase access to healthcare

Both candidates favor increased access to healthcare (1,2).

Increase income tax deductions for healthcare costs

Both candidates favor increasing income tax deductions for healthcare costs but their plans are different (1,2). Trump favors full deduction of health insurance premium payments from tax returns. Clinton favors a refundable tax credit of up to $5,000 per family for excessive out-of-pocket costs.

Price transparency

Both candidates favor increased healthcare price transparency (1,2).

Public option

Clinton favors a public option (1). Trump's position is unclear.

Reduce copays and deductibles

Clinton favors reducing copays and deductibles (1). Trump's position is unclear.

Sell insurance across state lines

Trump favors insurance companies selling healthcare insurance across state lines (2). This has been a part of the platform of every Republican presidential nominee and is permitted in 5 states but insurance companies have been reluctant to sell these policies (6). Clinton's position is unclear.

References

1. Hillary Clinton for America. Available at: https://www.hillaryclinton.com/issues/health-care/ (accessed 9/6/16).
2. Donald J. Trump for President. Available at: https://www.donaldjtrump.com/positions/healthcare-reform (accessed 9/6/16).
3. Salganicoff A, Beamesderfer A, Kurani N, Sobel L. Coverage for abortion services and the ACA. Kaiser Family Foundation. September 19, 2014. Available at: http://kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-and-the-aca/ (accessed 9/6/16).
4. Dickson V. GOP's Medicaid block-grant plan won't happen while Obama's in office. Medscape. March 19, 2015. Available at: http://www.modernhealthcare.com/article/20150319/NEWS/150319877 (accessed 9/6/16).
5. Norris L. Under the ACA, can I still have an individual HDHP and an HSA? Healthinsurance.org. May 16, 2016. Available at: https://www.healthinsurance.org/faqs/i-have-an-individual-hdhp-and-an-hsa-will-i-still-be-able-to-have-them-under-the-aca/ (accessed 9/6/16).
6. Cauchi R. Out-of-state health insurance - allowing purchases (state implementation report). National Conference of State Legislators. December, 2015. Available at: http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx (accessed 9/6/16).

Cite as: Robbins RA. Clinton's and Trump's positions on major healthcare issues. Southwst J Pulm Crit Care. 2016;13(3):126-8. doi: http://dx.doi.org/10.13175/swjpcc091-16 PDF

Troubles Continue for the Phoenix VA

According to the Joint Commission on the Accreditation of Healthcare Organizations (Joint Commission, JCAHO), an independent organization that reviews hospitals, the Phoenix VA does not comply with U.S. standards for safety, patient care and management (1). The hospital was at the epicenter of the national scandal over the quality of care being afforded to the nation's veterans where the now notorious practice of double-booking patient appointments was first exposed. The hospital's indifferent management provoked congressional investigations that uncovered still more system-wide abuses leading to the removal of the hospital director and the resignation of then VA secretary, Eric Shinseki. The hospital maintains its accreditation but with a follow-up survey in 1-6 months where it must show that it has successfully addressed the 13 identified problems (1). Inspectors who conducted the review in July found that VA employees were unable to report concerns "without retaliatory action from the hospital." Other alarming deficiencies were that Phoenix administrators did not maintain a "safe, functional environment" or "a culture of safety and quality." They concluded that the hospital does not have adequate policies and procedures to "guide and support patient care, treatment and services."

Elizabeth Eaken Zhani, a media relations manager at the JCAHO, stressed that noncompliance findings do not typically lead to a loss of accreditation (2). Of more than 4,000 medical facilities evaluated each year, she said, less than 1 percent are denied accreditation. The Phoenix VA has a right to appeal and an opportunity to correct failings so the hospital meets national standards. In a written statement October 20, VA officials said plans have been developed with an expectation that compliance issues will be resolved within 120 days. "We are also working diligently to address the cultural issues identified by The Joint Commission and have implemented a number of items to enable employees to raise concerns about safety or quality without fear of retaliation...".

In 2010, the Phoenix VA was among 20 VA medical centers to earn The JCAHO's "Top Performer" honor. The most recent audit, in 2011, showed Phoenix at or above target values established by the commission for every major category of health care and administration. It is unclear if care quickly deteriorated at the VA over three short years or previous JCAHO evaluations were inadequate. JCAHO inspections usually are conducted by a retired hospital administrator, physician and nurse. They usually review policies and procedures and rarely meet with physicians, nurses, technicians or clerks directly involved in patient care.

In an editorial entitled "After ALL THAT, Phoenix VA still fails review?!" the Arizona Republic (3) stated the "Phoenix VA is the hospital the VA would want to get right. The one at which the troubled agency would throw all its resources to assure that, despite all evidence to the contrary, VA leaders really did know what they were doing. And, yet, the Phoenix VA flunked its review". The editorial goes on to say that, "Perhaps the most fundamental flaw in the VA system is the forbidding culture of the organization, which regularly and ruthlessly punished whistle-blowers. You would think that, above all else, the VA's new administrators would strive to assure that that malignant practice was banished. Didn't happen. Failure to assure that a VA worker could 'report concerns about safety or the quality of care to (the reviewing agency) without retaliatory action from the hospital' was at the top of the Joint Commission's list of findings". The Republic goes on to say that "The Joint Commission's audit provides still more evidence of the intransigence [pigheaded] and resistance to change that the VA presents to even the most determined reformers".

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

References

1. The Joint Commission. Phoenix VA Health Care System: Summary of accreditation quality information. Available at: http://www.qualitycheck.org/qualityreport.aspx?hcoid=2508# (accessed 10/23/14).
2. Wagner D. Phoenix VA hospital fails outside compliance review. Arizona Republic. October 21, 2014. Available at: http://www.azcentral.com/story/news/arizona/investigations/2014/10/21/phoenix-va-hospital-fails-outside-compliance-review/17649623/ (accessed 10/23/14).
3. Editorial board. After ALL THAT, Phoenix VA still fails review?! Arizona Republic. October 22, 2014. Available at: http://www.azcentral.com/story/opinion/editorial/2014/10/22/phoenix-va-downsize/17748023/ (accessed 10/23/14).  

Reference as: Robbins RA. Troubles continue for the Phoenix VA. Southwest J Pulm Crit Care. 2014;9(4):240-1. doi: http://dx.doi.org/10.13175/swjpcc140-14 PDF