Trump v. Clinton: How They Line Up On Health

The Philadelphia Inquirer offers an analysis on the Candidate’s Position on health care. The following is a summary the article:

Health insurance

  • Clinton: Wants to improve the Affordable Care Act. She wants to reduce the cost of health insurance purchased on exchanges and provide a tax credit of up to $5,000 a family to offset out-of-pocket costs and premiums above 5% of household income. She would expand tax credits and cap the cost of premiums at 8.5% of family income. She calls for fixing the “family glitch” so families can access coverage in the exchanges when their employer’s family plan is not affordable. She would allow undocumented immigrants to buy insurance through the exchanges. In what is seen as a nod to Bernie Sanders’ supporters, she is affirming support for a public option that would allow people as young as 55 to buy health insurance through Medicare.
  • Trump: Opposes requiring people to buy health insurance. He wants to repeal the Affordable Care Act. He proposes to make coverage more affordable by allowing sales of health insurance across state lines and permitting people to deduct health insurance premium payments from their taxes. He would emphasize tax-deductible health savings accounts (HSA) where funds could accumulate if they are not used. He wants to require price transparency by health-care providers so that people can shop around for the best prices. He also wants would-be immigrants to certify that they can pay for their own health care.

Prescription drugs

  • Clinton: Wants to eliminate tax breaks that pharmaceutical companies get for direct-to-consumer advertising, and require those that benefit from federal research spending to reinvest profits into research. She would ban legal settlements in which pharma companies pay competitors so they will hold off on introducing generics and would allow consumers to import cheaper drugs from countries such as Canada. She supports allowing Medicare to negotiate lower drug prices and would cap out-of-pocket costs for people with chronic health problems.
  • Trump: Calls for a free market for prescription drugs, including allowing consumers to import them from countries that regulate prices. This practice is now illegal, though the law is not firmly enforced.

Medicaid

  • Clinton: Supports president Obama’s proposal to let states that sign up for Medicaid expansion to get a 100% match for the first three years. She would expand access to Medicaid and children’s health insurance.
  • Trump: Wants states to get federal Medicaid funding through block grants, which could mean fewer dollars for many states, but would give local officials more authority over expenditures.

Medicare

  • Clinton: Has vowed to fight proposals to privatize or phase out Medicare, and would give Medicare the power to negotiate lower drug costs.
  • Trump: Is against abolishing Medicare.

Social Security

  • Clinton: Opposes privatizing Social Security, reducing annual cost-of-living adjustments, and raising the retirement age. Clinton would expand Social Security for some, such as widows and caregivers, and help to fund the benefit through a wealth tax.
  • Trump: Has voiced support for Social Security and called it “honoring a deal.” He has said that Republicans cannot win elections if they seek to change it substantially.

Veterans Administration

  • Clinton: Says she would ensure more timely benefits, block privatization efforts, and strengthen services for military families and employment programs for veterans.
  • Trump: Has vowed to reform the agency and make it more efficient in delivering service and employment assistance.

Abortion

  • Clinton: Wants to protect access to safe and legal abortion.
  • Trump: Back in 1999, he told Meet the Press that, despite his personal dislike of abortion, “I’m very pro-choice.” More recently, he announced, “I am pro-life.” This year, Trump he said on MSNBC that if abortion were banned, women who violated the law would have to be punished. Soon after, his campaign released a statement saying that providers, not patients, should be held liable. His running mate, Indiana Gov. Mike Pence, has backed some of the nation’s toughest abortion restrictions.

HIV/AIDS

  • Clinton: Her proposals include funding research to seek a cure; finding more affordable treatment, including capping prescription costs; urging all states to extend Medicaid coverage for people living with HIV; and increasing use of HIV prevention medication.
  • Trump: Has not issued a policy on HIV and AIDS, though some in the advocacy media say his goals of lowering prescription drug costs and increasing transparency about health care pricing could be beneficial.

Medical research funding

  • Clinton: Advocates increasing funding for Alzheimer’s research to $2 billion a year, paying for care-planning services through Medicare, and funding a federal program to help locate Alzheimer’s patients who wander.
  • Trump: Has called funding for Alzheimer’s research “a total top priority,” but he has not offered many specifics about policies he would pursue. He has alarmed the research community with scientifically unfounded statements about Ebola, autism, and climate change.

Autism

  • Clinton: Has called for a nationwide early-screening campaign. She wants to push all states to require health insurance coverage for autism services, help get adults on the autism spectrum connected to employment opportunities, and fund more research.
  • Trump: In tweets and during a presidential debate, Trump has linked autism to some vaccinations, a tie that has been widely debunked by international medical authorities and advocates, such as Autism Speaks, a group that Trump has supported.

Addiction and drugs

  • Clinton: Would increase funds for addiction treatment and prevention, and emphasize rehabilitation over prison for low-level and non-violent drug offenses. She wants more preventive services for adolescents, opioid antidotes for all first responders, and more training for drug prescribers.
  • Trump: In New Hampshire, Trump vowed to fight addiction on two fronts saying, “First, we have to support locally based and locally run clinics, and we have got to close the border. That’s where the drugs are coming from.”

Medical marijuana

  • Clinton: Supports the use of medical marijuana.
  • Trump:.Supports the use of medical marijuana.

Family and medical leave

  • Clinton: Advocates a paid family and medical leave of up to 12 weeks with at least a two-thirds wage replacement rate. She proposes paying for the plan with taxes on the wealthy.
  • Trump: He told Stuart Varney on Fox News last year, “Well, it’s something that’s being discussed. I think we have to keep our country very competitive, so you have to be careful of it.”

Federal funding of Planned Parenthood

Clinton: Supports federal funding of Planned Parenthood.
Trump: At a news conference on Super Tuesday, Trump said he would not give federal funds to Planned Parenthood because the organization performs abortions. But he praised the health care it provides, saying, “millions and millions of women – cervical cancer, breast cancer – are helped by Planned Parenthood.”

Unemployment Benefits Actually Help the Economy – And the More Generous the Better

Research from Columbia Business School provides evidence that unemployment insurance helps stabilize the economy – and the more generous the benefits are, the better. As demand for products and services decline due to unemployment, the unemployment insurance allows for continual cash flow in the community, which can help preserve regional and local economic activity even in the face of mass layoffs. The more generous the unemployment insurance benefits are, the better the region fares.

Marco Di Maggio, co-author of the study and professor at Columbia Business School said, “We compared differences in the generosity of each states’ unemployment insurance programs. Our findings show that unemployment insurance appears to have a beneficial effect on the economy by decreasing its sensitivity to economic shocks and reducing the variability in total income, employment in the non-tradable sector and durable consumption.”

Di Maggio, and his co-author Amir Kermani from the University of California at Berkeley found that counties in states with more generous unemployment insurance react significantly less to economic shocks driven by falling demand.

Caregivers Face A Career Crisis

Providing care for loved ones has taken a toll on the careers of half of caregivers with 11% losing their jobs and another 10% having to change careers.  That’s in addition to the other financial, physical, and emotional effects of caregiving according to a Genworth study.

Fifty-one percent of caregivers say that that caregiving responsibilities impeded their ability to perform their jobs. The survey also reveals the following:

  • 77% missed some work during the past year, up 19% in 2010.
  • Caregivers missed an average of seven hours of work per week.
  • 19% missed 10 or more hours of work per week.

As a result of their caregiving responsibilities:

  • 11% lost their jobs.
  • 10% had to change careers.
  • 12% had to change positions.

Approximately one-third of caregivers provided 30 hours or more of care a week.  On average, caregivers lost one-third of their income. The study also highlights several factors that contribute to respondents’ reluctance to plan early. Thirty percent didn’t want to admit that long-term care may be needed and 25% didn’t want to talk about the issue.

Caregivers who had long term care insurance were reimbursed for 23% of their qualified out-of-pocket expenses. Forty-eight% of care recipients had considered the possibility needing long-term care, but only 26% made a plan to cover their potential needs. Even planners felt they could have been better prepared; 63% said they should have taken steps sooner, which would have led to reduced stress.

Millennial Workers Not Saving Enough to Get Company Matching Contributions

Participation in 401(k) plans is strong among workers in their 20s and 30s, but many are not saving enough to take full advantage of their employer’s 401(k) match – potentially leaving thousands of dollars on the table and hurting their long-term financial health, according to a study by Aon Hewitt. While the average participation rate of young Millennial workers (age 20 to 29) is 73%- and 77% for older Millennials (age 30-39), many are saving at a low rate. Nearly 40% of 20 to 29 year olds and 31% of 30 to 39 year olds are saving at a level that is below the company match threshold.

Rob Austin, director of Retirement Research at Aon Hewitt said, “Automatic enrollment has significantly improved participation in 401(k) plans for all employees over the past 10 years—but even more so for young workers. However, once they’re in the plan, young workers seem to fall victim to inertia with many continuing to save only at the default rate, or slightly above, and risking their long-term savings by not receiving the full employer matching contributions that are offered.”

Leaving matching contributions on the table can cost young workers a significant amount of long-term savings. Consider a 25-year old worker who makes $30,000 annually and works for an employer that provides the typically company match – $1-for-$1 up to 6 percent. If that 25-year old starts saving the full match amount of 6% immediately upon employment and continues to do so until she reaches age 65, she’ll have more than $950,000 saved in her 401(k).  If that same worker waits until age 30 to begin saving 6%, she will have less than $715,000 saved at age 65. Five years of missed 401(K) contributions will cost the employee her $225,000 over her career. In order to make up the gap, she would need to increase her savings by 4% percent and start saving 10% of pay each year for the next 35 years.

“For young workers, it may seem insignificant to increase 401(k) contributions by a few percentage points, particularly at a point in their career and life when they’re likely earning a smaller salary, but the long-term effects can be remarkable,” explained Austin. “Employers can help Millennials improve their financial outlook by encouraging them to save at least at the match threshold through targeted communications and online tools and resources. To take it a step further, they can also increase the default contributions so that workers are saving at the match threshold immediately upon enrollment into the plan, or by offering automatic contribution escalation, which increases a workers’ contribution rate over time. The bottom line is young workers need to save more, starting now.” For more information, visit www.aonhewitt.com.

Health Is the Number One Reason Canadians Delay Retirement

Sixty-nine percent of retired Canadians did not stop working on the date they planned. “Our research shows that Canadians who are not financially prepared to retire typically say they will work longer to compensate, but unfortunately, they may not have that choice,” says Kevin Dougherty, president, Sun Life Financial Canada. Though Sixty-six percent of Canadians cite that deteriorating health is a top concern as they age, only 22% have saved money or planned for healthcare expenses in retirement. The survey also reveals the following:

  • 53% worry about the cost of drugs and medical treatments in retirement.
  • 47% worry about being in long-term care longer than they are financially prepared for.
  • 45% worry about outliving their retirement savings.

For more information, visit www.sunlife.ca/CanadianHealthIndex.

Health Benefit Costs to Edge up in 2015

Employers are predicting that health benefit costs will rise 3.9% per employee in 2015, according to a Mercer survey. At 2.1%, cost growth reached a 15-year low in 2013, but appears to be edging back up. Employers say that costs would rise 5.9% if they made no changes to their plans for 2015. But only 32% of employers are simply renewing their plans without making changes. “Employers have to work hard each year to keep cost increases manageable. And health reform is certainly creating new challenges,” said Tracy Watts, senior partner and Mercer’s National Health Reform leader. Twenty-two percent of employer health plans are likely to see enrollment grow next year when they open their plans to all employees working 30 or more hours per week. Thirty-nine percent of the large retail and hospitality businesses, which typically employ many part-time workers, will need to extend coverage in 2015. Beth Umland, Mercer’s director of Research for Health and Benefits said, “While there has been much speculation that employers would reduce staff or cut hours to limit the number of employees becoming eligible in 2015, few…will take of those routes.” However, many say they will manage schedules more carefully to avoid workers’ occasionally working 30 or more hours in a week or to make it clear to new hires that they will work fewer than 30 hours, she added.” It’s hard to predict how many newly eligible employees (generally lower-paid, variable-hour workers) will enroll in health plans. The tax penalty for individuals who do not get coverage will rise in 2015 to a minimum of $325. The minimum was only $95 in 2014. Few employers have seen significant growth in enrollment. But 2015 could be a different story, not just because the penalty is higher, but also because many employees now have the option to enroll, said Watts. Consumer-directed health plans (CDHPs) that are eligible for a health savings account cost 20% less than traditional health plans. While about half of large employers offer a CDHP, 73% expect to have a CDHP within three years. And 20% say it will be the only option for employees. Today, only 6% of large employers have moved to full-replacement CDHPs. The move toward high-deductible consumer-directed plans is spurring more voluntary options. In addition, private benefit exchanges make it easier for employers to offer a range of medical plan options and voluntary benefits. For more information, visit www.mercer.com.

Young Adults Have High Interest in Obamacare

In the past nine months, nearly 60% of the individual health insurance inquiries generated by Verticalize have come from 18-year old to 34-year old consumers. When the age segment was expanded to the 18 to 44 year-old range, the number of health plan inquiries from this group represented 80% of total volume. As much as 45% of Verticalize’s recent sales have come from the 18 to 34 demographic. “We’re finding a much greater interest level from young adults in Obamacare insurance than on-exchange enrollment numbers reflect. Part of our success may be due to our avoidance of the political dimensions of health insurance. We call it the, ‘saying yes to healthcare moment.’ You aren’t saying yes to Obamacare, the president, or supporting one political party. What we try to reinforce is that you are simply saying yes to a better quality of life through sound insurance coverage,” said Sean Sullivan, CEO of Verticalize. According to RAND research, the majority of exchange enrollees were previously insured, but only 9.75% of 40,000 of Verticalize’s recent health plan inquiries were from people who have health insurance or had it. Of those with past or present insurance coverage, the insurance companies that had most frequently provided the coverage were Aetna, Blue Cross Blue Shield, and United Healthcare. For more information, visit Verticalize.net.

Nearly 1 Million Americans Could Leave Their Jobs Because of Health Care Reform

Up to 900,000 Americans could decide to stop working because of the Affordable Care Act, according to research from the University of Chicago Booth School of Business. The study is based on the abrupt end of Tennessee’s Medicaid expansion in 2005. That year, Tennessee dropped 170,000 of its citizens from Medicaid, which was the largest Medicaid disenrollment in the history of the program.

In 1994, Tennessee’s expanded its Medicaid public health insurance program to provide for uninsured and uninsurable adults regardless of age, income or family status, becoming one of the most generous in the country. But the program was ended  nine years later, largely due to budgetary constraints. Approximately 170,000 residents lost coverage.

Those who lost coverage were disproportionately single, childless adults with incomes slightly higher than the federal poverty line. That population is very similar to uninsured Americans who are likely to gain coverage under the Affordable Care Act.

Close to half of those who lost TennCare coverage in 2005 found insurance through an employer. As soon as TennCare coverage ended, there was a spike in Google searches for “job openings” in Tennessee.

“This shows that there are many people out there who look for work simply because they need health insurance. For them, the perk matters more than the paycheck,” says Tal Gross, co-author of the paper and assistant professor of Health Policy and Management at the Mailman School.

“The fact that people are working solely to get health insurance signals a failure of the private health insurance market,” explains Matthew J. Notowidigdo, Neubauer Family Assistant Professor of Economics at the University of Chicago Booth School of Business and a study co-author. “That’s one of the reasons why the Affordable Care Act was created.”

With Medicaid rapidly expanding under the Affordable Care Act, the researchers foresee that such a progression could happen in reverse: The option of public health insurance may lead some Americans to retire or to leave their jobs. This doesn’t make the Affordable Care Act a “job killer,” as some have suggested; it just provides an alternative way to procure health insurance that doesn’t require people to work for the “perk.”

“When the Affordable Care Act is enacted, hundreds of thousands of people may choose to leave the labor force or retire earlier…because they now have access to health insurance outside of their jobs,” explains Craig Garthwaite, assistant professor at Northwestern University’s Kellogg School of Management and a study co-author. “It’s giving people important options that otherwise wouldn’t exist without the ACA. Historically, health insurance in the United States has been tightly linked to employment, and the ACA weakens that link.” For more information, contact Ethan Grove at 773-834-5161 orethan.grove@ChicagoBooth.edu.

Research Finds Momentum for Health Care Payment Reform

Efforts are well underway to change the way health care providers are compensated. The trend is moving away from fee-for-service toward payment for a bundled set of services, according to research commissioned by the Health Care Incentives Improvement Institute. While some early commercial-sector adopters have abandoned bundled payments, other payers and providers in the public and commercial sectors are making it a part of their permanent reimbursement strategy. Certain challenges plague the carriers’ bundled payment efforts, including a lack of data, leadership, resources, and a lack of engagement in local efforts. For more information, visit www.HCI3.org.

Rate of Employer Coverage Rises After Massachusetts Health Reform

In the seven years since Massachusetts enacted its universal healthcare law, the number of people covered by insurance through the workplace increased, running counter to nationwide trends. Employer-sponsored insurance rose about 1% in Massachusetts while the national rate fell 5.7%. The Massachusetts growth occurred in the midst of the recession and at a time when health insurance premiums in the state rose to the highest levels in the nation, according to a study by PwC’s Health Research Institute.
Michael Thompson of PwC said, “Health insurance benefits are a significant part of the total compensation package for a workforce, and that’s not likely to go away when the Affordable Care Act goes into full effect. Employer-sponsored coverage will continue to be a critical pillar of the U.S. health system. It has been an important part of employer strategy to attract and retain talent, and promote improved health and productivity. Most employers see this return on investment, alone, as a compelling reason to continue offering coverage.”

A combination of salary and health benefits through an employer is likely to be more efficient way to be compensated for Americans earning more than 400% of the federal poverty level or about $45,960, according to researchers. Due to federal tax exclusions, businesses can save thousands of dollars per-employee by using that compensation strategy. The second report on the Massachusetts Experience, to be later this month, will take a closer look at the implications for the state’s hospitals, physicians and insurers. To download the report, visit: http://www.pwc.com/us/Massachusettshealthreform.

Last Updated 09/22/2021

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