What Could the Iowa Caucus Results Mean for Health Care?

Topics: Care Delivery, Access to Care, Costs and Prices, Health Care Spending, Medical Bills and Debt, Payments and Reimbursement, Health Care Reform, Prescription Drugs, Research and Development, Insurance, Medicare, Health Plans/Insurance Companies, Employer-Sponsored Coverage, Elections, 2016, Federal Government, Health Care Legislation, Providers, Public Health, Alzheimer's Disease, Substance Use

Sen. Ted Cruz (R-Texas), who is seeking the Republican presidential nomination, emerged victorious in yesterday's GOP Iowa caucus, while former Secretary of State Hillary Clinton and Sen. Bernie Sanders (I-Vt.), who are both seeking the Democratic presidential nomination, were separated by a small number of votes -- but big differences on health care. (As of this morning, the race between Clinton and Sanders in the Democratic Iowa caucus remained too close to call.)

There's still a long way to go in the presidential races. But now that the first voters have had their say, American Health Line is taking a look at what the top-performing candidates have said about the health care industry.

Cruz

Cruz famously led the charge to shut down the federal government in 2013 in an ultimately futile effort to defund the Affordable Care Act.

In his presidential campaign, he has called for "repealing every word of Obamacare," which he says is "the biggest job-killer in the country."

Cruz has not released a detailed proposal on how he would replace the ACA, but he said in the last GOP debate that the plan should focus on "expanding competition, empowering patients, and keeping government from getting in between [U.S. residents] and [their] doctors."

Cruz said he wants to allow insurers to sell plans across state lines even without an agreement between states, expand health savings accounts, and delink health insurance from employment.

Cruz has also attacked Donald Trump, who also is seeking the Republican presidential nomination, for his comments that "everybody's got to be covered" by health insurance and that "the government's gonna pay for it."

In addition, Cruz has advocated for FDA reform. Cruz in December introduced the RESULT Act, which would give FDA just 30 days to decide whether to approve "life-saving" drugs and medical devices that already have been approved by certain "trusted, developed countries." Congress could then override an FDA decision through a majority vote.

Cruz also has:

  • Blasted first lady Michelle Obama's efforts to promote healthy foods in public schools, telling a group of young Iowan students that if his wife "Heidi Cruz becomes first lady, French fries are coming back to the cafeteria"; and
  • Pledged to defund Planned Parenthood.

Clinton

Clinton is no stranger to health care. While she's best known for her attempt to pass health reform during former President Bill Clinton's administration, her campaign website touts her work on the issue dating back to 1979 -- nearly four decades ago -- when she chaired a committee on rural health care in Arkansas.

In the presidential race, Clinton has been a staunch defender of the ACA, calling it "a huge accomplishment for our country," and of Planned Parenthood. Clinton she has put forward at least four new health care plans: to decrease out-of-pocket costs, curb the costs of prescription drugs, boost Alzheimer's research, and increase autism screening and coverage.

Several of those proposals are aimed at addressing individuals' health care costs, including:

  • A $250 monthly limit on consumers' out-of-pocket spending for drugs covered by their health plans;
  • Two new tax credits, one for individuals with high out-of-pocket costs and another for family caregivers;
  • Protections from "surprise" medical bills; and
  • A requirement for insurers to cover three sick visits annually that wouldn't count toward a consumer's deductible.

Like Trump and Sanders, Clinton has said Medicare should be allowed to negotiate drug prices.

Clinton has also specifically called for implementing new value-based systems and expanding alternative payment models such as bundled payments and ACOs. Her campaign in September 2015 pledged to put out a fifth health care plan with the full details of her delivery system reform plans "in the coming months."

Clinton has also attacked her Democratic rival Sanders' support for a single-payer system, describing it as an unrealistic proposal that would throw the country "back into a terrible, terrible national debate."

Sanders

Sanders has long advocated for single-payer, universal health care.

In a plan he unveiled last month, Sanders said, "It is time for our country to join every other major industrialized nation on earth and guarantee health care to all citizens as a right, not a privilege."

Sanders says his "Medicare for All" plan would cost about $1.4 trillion annually and would be paid for through several tax increases, including a 2.2% tax on health care premiums, a 6.2% health care payroll tax on employers, and various tax increases for U.S. residents with the highest incomes.

Sanders also estimates that his plan would generate significant savings, including by eliminating insurance companies' profits and administrative costs and by lowering spending on prescription drugs. According to an analysis released by Sanders' campaign, his proposal could reduce U.S. health care spending by more than $6 trillion over 10 years, when compared with the country's current health care system.

-- by Josh Zeitlin, associate editor