Evaluating Presidential Candidates’ View on Health Care

Republican presidential candidates agree on one thing – they all want to replace ObamaCare. But they differ in the ways they would achieve that same goal.

So far, Senators Ted Cruz and Rand Paul have declared their candidacy in formal announcements and Senator Marco Rubio is expected to do the same this week. Others will be declaring their intentions soon. This is a good time to review what we know about each candidate’s views on ObamaCare replacement

Michael Tanner reviewed the candidates for National Review Online. He says that no one is more outspoken than Senator Ted Cruz regarding his intentions. Cruz has vowed to “repeal every word” of ObamaCare. Cruz has sponsored the Health Care Choices Act, which would allow insurance plans to be sold across state lines as long as they met certain minimum consumer protections.

He has called for health insurance to be “personal, portable, and affordable.” This means you could take your health insurance policy with you when you change jobs, just like a 401K plan and this would eliminate the problem of “pre-existing conditions.” He would likely support proposals to provide the same tax breaks for individuals currently enjoyed by those receiving employer-provided insurance.

Senator Marco Rubio has put forth the most detailed proposal for replacing ObamaCare of any candidate thus far. In his book, American Dreams: Restoring Economic Opportunity for Everyone, Rubio says he would provide all Americans with a refundable tax credit that could be used to purchase insurance, while gradually reducing the tax break provided for employer-based insurance. He is looking ahead and planning for a more balanced evolution of insurance subsidies toward a level playing field that eventually treats all purchasers the same. Like Cruz, Rubio calls for allowing the purchase of insurance across state lines.

Rubio also calls for setting up state-run, but federally funded, high-risk pools to assist individuals with pre-existing conditions. He also has been a leader in opposing any bailout of insurance companies that lose money due to ObamaCare.

Just announced candidate Senator Rand Paul has not yet put forward a detailed ObamaCare replacement plan. He has called for expanding Health Savings Accounts (HSAs) by removing the requirement that they be linked to a high-deductible insurance policy. He would expand the tax-deductibility of healthcare expenditures more generally and allow purchase of health insurance across state lines. He has also urged tort reform at the state level.

Former Florida Governor Jeb Bush sees a larger role for the federal government than these three senators. He has called for the government to create “catastrophic coverage” for those families and individuals who have a hardship that goes beyond your means of paying for it. He wants a “consumer-driven” healthcare system where patients have more choices and control.

He believes subsidies to purchase insurance should be administered by the states, not the federal government. He says the same about exchanges; if they continue, they should be state-run and non coercive, giving people more choices and eliminating any employer or individual mandates

Louisiana Governor Bobby Jindal was a health-policy wonk before becoming a governor. He has a detailed plan to replace ObamaCare in which he would eliminate the current tax preference for employer-sponsored insurance, replacing it with a standard deduction for the purchase of individual insurance. Some have criticized this plan for reducing the number of people covered, especially those with low-incomes.

To compensate, he would establish a $100 Billion fund for states to subsidize affordable health insurance for low-income families and those with pre-existing conditions. Like the others above, he would expand HSAs, allow purchase of insurance across state lines, and calls for tort reform.

Wisconsin Governor Scott Walker has not put forth much in details of how he would replace ObamaCare. He refused to expand Medicaid in Wisconsin, but did send a letter to the Obama administration proposing that individuals be allowed to use ObamaCare tax credits to purchase any insurance plan sold in their state rather than just those sold on the exchange. He also reduced the rolls of Medicaid in Wisconsin by eliminating those above 100% of the Federal Poverty Level since they would be eligible to receive subsidies on the exchange.

New Jersey Governor Chris Christie hasn’t declared his intentions for the presidency nor his healthcare plan. But he has said Republicans must not just repeal ObamaCare but replace it with something better. He has called for giving states a larger role in healthcare and he did expand Medicaid, unlike most Republican governors.  He has called for “a robust debate among both sides,” but apparently has missed the debate that has been going on for the last five years or more.

Retired neurosurgeon Ben Carson would be expected to have much to say about healthcare reform and he hasn’t disappointed. His rise to national prominence began with his comments at the National Prayer Breakfast when he criticized ObamaCare. He endorsed my book, The ObamaCare Train Wreck, which calls for replacement of ObamaCare

He has called for the federal government to fund a HSA for every American with a $2000 contribution per year. People would be required to use at least a quarter of the payment to purchase bridge insurance or catastrophic insurance, and all citizens would have the right to contribute to their HSA from other sources without limit.

The cost of this program has been estimated at $700 Billion and would result in universal catastrophic coverage. Once people’s account balances reached a level sufficient to ensure their protection from healthcare-related expenses, Carson would allow them to withdraw the savings for retirement or other purposes.

Other undeclared candidates such as former governors Rick Perry of Texas and Mike Huckabee of Arkansas have said little about healthcare so far. Perry declined to expand Medicaid in Texas and has passed tort reform legislation in his state. Former Senator Rick Santorum of Pennsylvania has been a vocal backer of HSAs and favors allowing purchase of insurance across state lines. He also favors tax credits to help low-income Americans purchase insurance.

This is not an exhaustive list of those Republicans considering running for the presidency, but it does cover the current most frequently mentioned names. Republicans all favor replacement of ObamaCare with a better system of healthcare. The issue now is to decide which plan is the best and who is the candidate most qualified to lead the Republican party and the country.

There can be no doubt what Hillary Clinton will do if she is elected president. In 1992, as First Lady under President Bill Clinton, she was tasked by her husband with reforming healthcare. Her plan, often referred to as HillaryCare, bore a remarkable similarity to ObamaCare. If Americans want to keep ObamaCare, and every poll taken says they don’t, they need only elect Hillary president. If that should happen, ObamaCare is here to stay.

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