Oct 18 When former President Bill Clinton called
parts of Obamacare "crazy," he put his wife Hillary Clinton on
the defensive and gave much-needed ammunition to her Republican
rival for the presidency, Donald Trump, who wants to scrap it.
Bill Clinton said this month that while millions more
Americans now have insurance coverage under President Barack
Obama's signature 2010 healthcare law, small businesses and some
families are still "getting killed" by surging healthcare costs.
He later clarified that he was not criticizing the entire
initiative, he was just making an argument for fixing it.
Still, Clinton's comments may not have been so crazy. He put
a spotlight on an uncomfortable truth: after six years, billions
of dollars and a sweeping reform that stands as Obama's single
biggest domestic policy achievement, health care is still
unaffordable for many Americans.
Americans are growing increasingly anxious about rising
healthcare costs, and critics of the law have said it is not
living up to its promises. Two of the nation's largest health
insurers, Aetna and United Healthcare, are also pulling out of
the state-based health insurance exchanges that are the
best-known creations of Obamacare.
Clinton says she wants to save the best of Obamacare, also
known as the Affordable Care Act, while reducing costs. Trump
says it is an expensive "disaster" that is on track to implode
in 2017. He wants to replace it with something cheaper.
Whoever wins the presidency on Nov. 8 will likely face
pressure to move quickly to reshape a healthcare initiative that
affects millions of Americans.
WHY CONSERVATIVES THINK OBAMACARE IS CRAZY
Republicans opposed Obamacare from the start, labeling it a
government intrusion into the healthcare market.
Some of them say the individual exchanges where Americans
shop online for coverage are already in a "death spiral." They
warn that with fewer consumers using the exchanges, more health
insurers will exit them, sending premiums even higher, and
further deterring people from signing up.
As the U.S. population ages, U.S. spending on healthcare -
$2.9 trillion in 2014 - is projected to rise to more than
one-fifth of the nation's gross domestic product. Spending rates
under Obamacare did slow for a time, but they are on the rise
Trump has proposed getting rid of the exchanges and setting
up tax-free health savings accounts for people with
high-deductible insurance plans. He has also said he would set
up state-based high-risk pools for people with medical
conditions that make it hard to get coverage on their own. He
also wants to allow companies to sell insurance across state
lines to boost competition and drive down prices.
His advisers say he would draw on a plan proposed by
Republicans in the U.S. House of Representatives, which includes
a refundable tax credit to help Americans buy individual plans.
Republicans, like Trump, also want to change how they fund
Medicaid, which serves poor families. Obamacare increased
federal funding to states that expanded the program to more
people with low incomes. Now Trump wants to limit funding by
switching to pre-set, block grants.
Health policy experts are skeptical selling insurance across
state lines would do much to rein in health insurance costs. And
health wonks on both sides of the aisle said Republicans would
likely balk at any proposals that threatened to yank health
insurance away from 20 million people.
"Even Republican members of the House and the Senate are
going to end up resisting rolling back the Medicaid expansion if
that means that lots of people in their states would go
uninsured," said Jim Capretta, a health policy expert at the
right-leaning American Enterprise Institute.
LIBERALS DON'T THINK IT'S CRAZY, BUT...
Liberals like former Democratic presidential candidate
Bernie Sanders haven't called Obamacare crazy, but Sanders does
believe it doesn't go nearly far enough. During his campaign, he
proposed replacing it with a single-payer insurance system he
called "Medicare for all," based on the government plan for
elderly and disabled Americans.
Hillary Clinton's plan doesn't go that far, but she would
build on Obamacare by expanding tax credits for people shopping
on the individual marketplaces, letting Americans buy into
Medicare at a younger age, and adding a "public option," or a
government-run insurance plan to compete with private insurers
on the exchanges.
She has also proposed reducing Americans' out-of-pocket
expenses outside their private insurance by offering a new
refundable tax credit, and she would give states more federal
funding to expand Medicaid for low-income people.
Two-thirds of states expanded Medicaid under the 2010 law,
and that's where most of the newly insured people got coverage.
Policy experts said that after Obama leaves office, more
Republican-led states that objected to a plan so closely
identified with Obama might be willing to expand Medicaid too.
Clinton's ability to expand tax incentives likely depends on
which party controls the U.S. Congress. And while some states
could act independently to launch public plans on their
exchanges, many Republicans view the idea as wildly expensive
and would strongly resist any effort by Clinton to require them
WHAT EVERYONE THINKS IS CRAZY - DRUG PRICES
Obamacare did little to deal with soaring drug prices for
lifesaving treatments like Mylan NV's EpiPen. Democrats
and Republicans say that's a problem for the next president,
even though it's getting little attention on the campaign trail.
Trump and Clinton both want Americans to be allowed to buy
cheaper drugs from overseas (Americans pay the highest prices in
the world for drugs). Former Democratic U.S. Representative
Henry Waxman made a similar proposal in 2009, but he was
defeated by pressure from drug companies, which would likely
oppose it again.
Clinton says Medicare should negotiate drug prices with
companies, using its 55 million users to get a better deal.
Trump made a similar call during the Republican primaries but it
does not appear on his campaign website now.
Some health policy experts believe drug companies would
respond to lower prices for Medicare patients by raising prices
for everyone else. And to negotiate better prices, Medicare
would have to be willing to stop covering certain drugs, which
would be unpopular, they say.
Clinton has also suggested creating a commission that would
watch for sudden spikes in prices of older life-saving drugs, a
proposal that health policy experts said is achievable through
rule making rather than legislation. She has also proposed a cap
on drug co-payments.
Clinton has already put Wall Street on watch. Her tweets
have brought down shares of Mylan and Valeant Pharmaceuticals
International, which helped push many institutional
investors out of healthcare stocks.
Drug companies are already responding to political pressure.
Botox maker Allergan Inc, for example, recently
committed to keeping price increases below 10 percent.
(Reporting by Caroline Humer in New York and Emily Stephenson
in Washington; Editing by Caren Bohan and Ross Colvin)