Why are the 2016 presidential candidates ignoring healthcare?

It’s time for the 2016 presidential candidates to start talking to voters-especially physicians-about where they stand on healthcare issues. But so far, the candidates have largely avoided this important discussion.

Like what you're reading? Sign up here for our eNews for more from Medical Economics!

Four years ago, Americans could hardly turn on the television or scroll through the news without hearing presidential candidates talking about the Affordable Care Act (ACA). Re-electing Barack Obama or electing Mitt Romney determined the future of the healthcare reform law–a law that many see as the first iteration of a universal healthcare system in the United States. 

What a difference a single presidential cycle makes. Granted, recent terror attacks across the globe have shifted the focus for both candidates and U.S. citizens. According to a December 2015 Gallup poll, 27% of Americans say terrorism/the threat of ISIS is the nation’s most pressing matter vs. just under 4% citing the state and cost of healthcare.

But as U.S. healthcare spending reaches $3 trillion annually (or more than $9,500 per person) and accounts for nearly 18% of the nation’s Gross Domestic Product, surely that should garner some time in nationally televised debates and campaign speeches.  

Healthcare legislative ­action to watch in 2016

“We all know that the Affordable Care Act or Obamacare was the big conversation in the past election cycle and now we’re in the wake of that,” says Dabney Evans, PhD, MPH, assistant professor of global health in the Rollins School of Public Health at Emory University in Atlanta, Georgia. 

Next: Where are their focuses instead?

Despite the fact that healthcare is not one of the primary issues in the campaign thus far, lack of access to care, reproductive health rights, medication and insurance costs, Medicare financing, and the future of the ACA are all very real concerns that aren’t being addressed by those who hope to be the next president. 

Top 10 challenges facing physicians in 2016

“I find it somewhat remarkable that, unlike in 2011, the election is not more focused on issues of healthcare. Remarkable since healthcare reform arguably gave birth to the Tea Party movement, and likely cost Democrats both the majority in the House in 2010 and helped chip away at their Senate majority,” says Cindy Ehnes, Esq., executive vice president at COPE Health Solutions, a healthcare consulting firm in Los Angeles, California. 

So, why aren’t the candidates openly discussing these issues? Perhaps one reason is because, at this stage in the election, candidates prefer to remain vague about many issues, not just healthcare. 

“This early in the campaign cycle, candidates are more focused on defining who they are than providing policy specifics,” says Ricardo Martinez, MD, FACEP, chief medical officer of North Highland, a consulting firm based in Atlanta, Georgia, that works with clients on healthcare issues. “As the field narrows down, the candidates begin to differentiate themselves with greater focus on policy issues. Healthcare will certainly be one of them.”

Top 12 worst and best paying states for internists

Painting issues in broad brushstrokes is fine up to a point, but some observers suggest that candidates aren’t providing details because there are no simple answers to these controversial issues–or that candidates simply don’t have any. The ACA is a good example. 

Next: More than 'repeal and replace'

“On the Democratic side, I think we see [Hillary] Clinton sort of building on the Affordable Care Act. We see Bernie Sanders talking about more of a one-payer plan,” says Barbara Glickstein, codirector of the Center for Health, Media & Policy at Hunter College in New York City. “And on the Republican side, what we’re seeing is not answering the question. Trump says repeal it and we’ll replace it; he’s never said anything about what that plan would look like. [Marco] Rubio has offered only opposition; I don’t think he’s come up with a specific plan.” 

Medical Economics reached out to 12 of the leading candidates in the upcoming presidential election, seeking more specifics on their healthcare platform (see page 29 for table). With the exception of an e-mail from the Clinton campaign, none of the other candidates returned e-mails or phone calls to elaborate on how they would address healthcare if elected next November.

More than ‘repeal and replace’

Whether it is repealed or not, the ACA is now in effect, and there are still many unresolved issues surrounding it, especially in conjunction with other frequently-discussed topics such as immigration reform. Many Americans still don’t understand the law, and specific groups such as young adults, immigrants, and early retirees need help accessing, using, and understanding the system. 

Bernie Sanders’ ‘Medicare-for-all’ gets mixed reviews by physicians

Additionally, in the wake of the Hobby Lobby Supreme Court decision allowing for-profit companies to skirt some provisions of the ACA based on religious objections, the next president will have to address access to reproductive care and family planning services, Evans says. “The complexity of these conversations doesn’t make for easy, quick news bites,” she says.

Next: Breaking down each candidates' positions on important issues

Next: Republican positions

Next: Republicans continued

Next: Reactions

Once candidates for both parties are selected, they will need to address the ACA head on, but until then there may not be much to say. At this point, the Democrats  have gone all in with the ACA; the only question is how they’ll work through the remaining challenges of the legislation in the years to come. 

As for the GOP, “The Republican primary candidates all want to repeal and replace Obamacare, and since they basically agree on that, it’s not an issue that creates sharp distinctions between them in the primary season,” says Joanne Kenen, healthcare editor for Politico/Politico Pro. “They may or may not have outlines of replacement plans at this stage, but voters don’t really understand the technicalities of health policy. They aren’t going to really understand the difference, say, between [Jeb] Bush’s tax credit proposals and [Marco} Rubio’s.”

Ehnes adds: “Likely the Dems do not want to really discuss healthcare because, despite successes, they know that Obamacare remains a political punching bag for GOP voters, with many cost and quality issues vulnerable to attack.”

Though the ACA is the healthcare topic that everyone seems to be avoiding, other important subjects will have to be addressed during the next presidential term, including the future of value-based payments, the continuing evolution of health information technology, and the overall costs of care. For example, 76% of Americans said that making sure high-priced drugs are affordable for those who need them should be a top healthcare priority for the president and Congress, according to a Kaiser Family Foundation poll from April 2015. 

A separate poll conducted by Kaiser in August 2015 indicated that 93% of Democrats, 83% of independents and 74% of Republicans want the government to negotiate drug prices for Medicare.

Next: Final analysis

In fact, the cost of prescription drugs has been openly discussed by a few candidates: Clinton has been vocal about lowering costs and unveiled a plan on how to do so in late September. Sanders also regularly brings up the price of drug prices on the campaign trail, and Republican Rubio has said he wants to see prices come down, but other Republicans have remained largely silent on the subject. 

“I see this becoming a bigger health policy campaign issue in 2016,” Glickstein says. “We are seeing more stories in the media about people who can’t afford to buy drugs, people who are sharing drugs. It isn’t going away.”

Healthcare in the United States is regarded in many ways as a luxury, not a right –“we literally call it a benefit,” Evans points out. In the final analysis, she says, Americans need to decide if there is a right to health and health insurance, and, if so, how that can be achieved in this country. “That’s the question that no one is asking but we all should be asking ourselves.”