The health care topics missing from the presidential debate

Topics: Health Care Reform, Politics and Policy, Elections, 2016, Insurance

By Heather Drost, senior editor

For many health policy wonks, the first presidential debate left many topics unanswered. That's because during the nearly two-hour debate, the moderator raised zero questions about health care.

But while Democratic presidential nominee Hillary Clinton and Republican presidential nominee Donald Trump did not discuss their health care proposals, it's worth taking a step back and considering how they would approach some of the country's biggest health care issues if elected president.

Rx drug prices

The increasing price of prescription drugs is one area where Democrats and Republicans appear to align. Both Clinton and Trump have condemned recent price hikes and voiced support for proposals that would allow the United States to import prescription drugs from other countries and would allow Medicare to negotiate drug prices.

Clinton also has proposed creating a federal panel to monitor and respond to drug pricing increases.

In addition, Clinton has said she broadly supports CMS' proposal to test new payment models for outpatient prescription drugs under Medicare Part B. Trump has yet to comment on the proposal but his party is strongly opposed.

The health insurance exchanges and uninsured population

The future of the Affordable Care Act's (ACA) health insurance exchanges is a question worrying many industry observers and a key policy issue for the next president.

The exchanges have had a rough year. Several prominent insurers significantly reduced or completely ended their participation, while remaining insurers have proposed significant premium increases for the 2017 open enrollment period.

What the latest insurer exits mean for the ACA exchanges >>>

For his part, Trump repeatedly has said that he would repeal the ACA, making it likely that he would try to dismantle the exchanges. To replace the ACA, Trump has proposed reducing barriers to selling insurance across state lines, allowing for "full competition" in the insurance market, which he says could drive down costs and increase consumer satisfaction.

Clinton has voiced her support for the exchanges and likely would push for policies to ensure stability, such as increasing exchange enrollment and limiting consumers' financial burden. Clinton also has proposed expanding eligibility for the exchanges to undocumented immigrants.

Medicare/Medicaid

Medicaid could be poised for significant changes depending on who wins the presidential election.

Clinton likely would continue the Obama administration's efforts to pursue Medicaid expansion in more states, while Trump said he supports moving to a block grant program.

However, Trump also has voiced support for extending health coverage to low-income U.S. residents. During an interview in February on ABC's "This Week," Trump said, "You can't have a ... small percentage of our economy, because they're down and out, have absolutely no protection so they end up dying from, you know, what you could have a simple procedure or even a pill" to treat. His formal health care plan on his website, however, does not include this proposal.

The two candidates have not released detailed plans for Medicare. Clinton has proposed lowering the age limit when individuals can buy in from 65 to 55, while Trump has said he'd keep Medicare "the way it is" if elected.

VA reform

Both candidates have released detailed plans to reform Veterans Affairs (VA) that include proposals to increase access to mental health care for veterans. Trump's plan relies heavily on giving veterans access to private-sector providers, which some say effectively would make VA more of an insurance provider than a health care system.

Clinton has opposed completely privatizing the VA health care system, but says that if elected she would continue VA's current approach of combining VA's stand-alone health care services with private-sector care to address care gaps for certain services and in particular regions.

Short road ahead

With just six weeks until the presidential election, industry stakeholders will be looking toward the second presidential debate on Oct. 9 to see whether Clinton and Trump will address their sharp disagreements on health care. But what is clear is that, no matter who occupies the White House next year, the next president will face a major obstacle in convincing an often-unproductive Congress to unite around and pass reforms.