New Hampshire voters last week handed resounding primary victories to Republican presidential candidate Donald Trump and Democratic candidate Vermont Sen. Bernie Sanders -- introducing new uncertainty about the consequences of this year's elections for health care policy.
Earlier this month, American Health Line explored the health policy stances of the Iowa caucus winners, Hillary Clinton and Ted Cruz. Now that New Hampshire has boosted the prospects of two different presidential candidates, it's time to dig in to the health policy views of Trump and Sanders.
In his victory speech in New Hampshire, Trump repeated his pledge to "repeal and replace Obamacare," which he called "a total disaster." But it's what he's said he would replace it with that makes the real-estate tycoon's health care views so unique in the GOP field.
"Everybody's got to be covered," Trump told CBS' "60 Minutes" in September. "This is an un-Republican thing for me to say," Trump noted -- but, he added, "I don't care if it costs me votes or not."
Trump said he "would make a deal with existing hospitals to take care" of low-income people who otherwise could not afford coverage. He said that the "government's gonna pay for it," but that it would "save so much money on the other side."
Trump hasn't released a fleshed out plan -- he told ABC's "This Week" that his administration would "work something out."
But ultimately, as Philip Klein notes in the Washington Examiner, his proposal could potentially mean a bigger government role in health care than under the Affordable Care Act, as would his support of Medicare negotiating drug prices directly with pharmaceutical companies. That policy, too, has been long opposed by Republican lawmakers but supported by many Democrats, including former Secretary of State Hillary Clinton and Sanders, who are seeking the Democratic presidential nomination.
At the same time, Trump has voiced support for several health care ideas that are typically supported by Republicans, including:
- Allowing insurers to sell plans across state lines without an agreement between states;
- Supporting health savings accounts; and
- Leaving health insurance to private plans that are largely unregulated by the federal government.
Vermont Sen. Bernie Sanders
Sanders used his victory speech to repeat his call for single-payer, universal health care. "In a time when every major country on Earth guarantees health care to all of their people," Sanders said, "we should be doing the same in our great country."
Sanders Unveils Universal Health Care Plan >>>
He added, "In my view, under President Obama's leadership, the [ACA] has been an important step forward, no question about it. But, we can, and must, do better. Twenty-nine million Americans should not remain uninsured."
He reserved special scorn for the profits of the pharmaceutical industry, which he called an "obscenity." He added, "When we make it to the White House, the pharmaceutical industry will not continue to rip-off the American people."
Sanders has said his ACA alternative, which he calls "Medicare for All," 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 Americans with the highest incomes.
The Vermont senator 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.
However, a recent Committee for a Responsible Federal Budget analysis found that Sanders' tax increases would raise about $3 trillion less over the next decade than his campaign estimates.
-- by Josh Zeitlin, associate editor