Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

How Presidential Nominees May Change World of the Health Payer

Once the new president is elected at the end of the year, the country will see which direction the health payer field will move in the coming years.

By Vera Gruessner

- The future of the healthcare industry hangs in the balance as the presidential nominees within the United States have their own plans for how to improve the consumer experience and the world of the health payer. Some of the most transformative ideas come from Democratic Senator Bernie Sanders in which he hopes to allow all Americans to move onto a Medicare and Medicaid system.

Affordable Care Act

Bernie Sanders

Sanders has announced that his Medicare-for-all plan would lead to quality healthcare at lower cost for all American citizens, according to a press release from his campaign website. The senator is looking to expand upon the Patient Protection and Affordable Care Act as well as open up the Medicare program for more Americans to join. Sanders took part in creating some of the regulations under the Affordable Care Act, the press release stated.

Consumers would be able to choose which doctors they would like to visit as well as which hospitals, post-acute care facilities, rehabilitation centers, and specialist clinics they’d be interested in receiving medical care from. Today, these capabilities are rather limited depending upon whether a certain provider takes the patients’ insurance coverage.

Gerald Friedman, an economist at University of Massachusetts at Amherst, has released an analysis that shows the Medicare-for-all plan would save the healthcare industry about $6 trillion over the next decade. Essentially, the plan set out by Bernie Sanders is thought to be able to save the costs associated with more expensive private health insurance options.

READ MORE: Will Health Insurance Exchange Remain Intact Despite Hurdles?

According to the analysis from Friedman, the average working family of four making $50,000 per year would save about $6,000 annually under Bernie Sanders’ plan. There would no longer be high premiums and deductibles found under private insurance and the working family of four would pay only $466 to the Medicare-for-all coverage program.

While businesses would have an increase in their taxes, they would no longer be required to provide private health insurance options to their employees, which would save them an average of $9,400 per year in healthcare spending under the plan set out by Bernie Sanders.

“Universal healthcare is an idea that has been supported in the United States by Democratic presidents going back to Franklin Roosevelt and Harry Truman,” Sanders said in a public statement. “It is time for our country to join every other major industrialized nation on earth and guarantee healthcare to all citizens as a right, not a privilege.”

Hillary Clinton

Presidential nominee and former Secretary of State Hillary Clinton has a different approach to the healthcare industry and the future of the health payer space. According to Clinton’s campaign website, the nominee will work towards preserving the Affordable Care Act and prevent “Republican efforts to repeal it.”

READ MORE: California Health Insurance Exchange Targets Costly Hospitals

Clinton will move toward expanding affordable coverage to more people under the healthcare law as well as stabilize the rising costs of medical care including the price of prescription drugs. Hillary Clinton is also looking to decrease the costs of copays and deductibles, which have only been rising over the last decade. While the rates of out-of-pocket spending growth has slowed down since the Affordable Care Act became law, it has not stopped completely or reversed direction. Clinton is looking to further work toward stopping this spending growth of copays.

In particular, the former Secretary of State hopes to lower the costs of prescription drugs, which have risen from a growth rate of “2.5 percent in 2013 to 12.6 percent in 2014.” Clinton aims to work toward decreased drug spending among the elderly and working families.

The Affordable Care Act, however, has moved forward in expanding Medicaid coverage around the nation, especially in the states that have agreed to receive the federal funding for Medicaid expansion. A total of 26 states are expanding Medicaid coverage while 19 have refused the funding from the federal government and six states are using an alternative method to increase Medicaid coverage.

Additionally, Hillary Clinton plans to work toward expanding healthcare access among those living in rural areas around the country. She hopes to improve the number of providers eligible for telehealth reimbursement under the Medicare program especially rural medical facilities. Clinton promises to encourage states to expand licensing for telemedicine and develop ways to open up reimbursement avenues for different types of healthcare services.

Ted Cruz

READ MORE: Consumer Engagement Vital in Health Insurance Exchanges

On the other side of the spectrum, presidential hopeful Ted Cruz along with a large number of other Republican Senators are looking to put an end to the Affordable Care Act. The Hill reported on an alternative plan set out by Senator Ted Cruz (R-Texas) to replace the major healthcare law developed by the Obama administration.

The Health Care Choices Act would allow Americans to purchase medical coverage plans from a preferred health payer across state lines. Cruz looks to repeal much of the Affordable Care Act including the health insurance exchanges, federal subsidies to help Americans afford coverage through the exchanges, and the individual mandate requiring all citizens to purchase healthcare coverage.

“The administration has done absolutely nothing to prepare for an upcoming Supreme Court decision that could leave millions of Americans unable to afford insurance thanks to this failed law,” Cruz said in a public statement. “Republicans must offer the American people alternatives that lower costs and break the status quo that favors big government and big healthcare business over hardworking Americans.”

“Every last word of Obamacare must be repealed,” Ted Cruz continued. “And while we continue that fight, we must also send bill after bill to the president’s desk to stop its harmful effects.”

Another important topic on Cruz’s campaign website illustrates his policies with Planned Parenthood.

“Ted Cruz will preserve life, marriage, and the family, and he has the record to prove it,” the campaign website states. “If Ted is elected president, he will instruct his Attorney General to investigate Planned Parenthood on day one.  And rather than enacting policies that tear down these pillars of our society, he will work to restore a culture of life, marriage, and family.”

Ben Carson

Another Republican presidential candidate that could affect the health payer industry and the future of the medical field is retired neurosurgeon Ben Carson. According to Carson’s campaign website, the plan under this particular presidential candidate is to create personal accounts and “first-dollar coverage” for individual consumers to cover out-of-pocket costs and premiums under their preferred health insurance plans.

Additionally, the funds in these personal accounts are meant to be transferrable among family members depending upon the health issues and needs of every patient. Medicare beneficiaries would also be given an option to contribute to their account to buy the healthcare coverage they desire while the Medicare program will have eligibility age increased to age 70 over time (an increase of two months per year).

These are only some of the plans that presidential hopefuls have for the future of the health payer industry. Once the new president is elected at the end of the year, the country will see which direction the healthcare field will move in the coming years.


Sign up for our free newsletter:

Our privacy policy

no, thanks