Handwriting on the Wall

Handwriting on the Wall:
An Examination of the 2016
Republican and Democrat Platforms
on Healthcare in the United States

October, 2016 by Gary M. Votour, MHCA

fx1No piece of legislation has created more political division in this country in recent years than the Affordable Care Act (ACA). The upcoming presidential election is certain to affect the outcome of the ACA, yet there is little public debate on this important issue.

Instead, this presidential election has become more about the personalities of the two candidates. 

Putting aside those differences and the entire debate over who is more qualified to be president, this blog will look briefly at the ACA, describe some of its successes and shortcomings, and give you a overview of how both the Democrat and the Republican parties will likely proceed after the election.

The Affordable Care Act (ACA) aka Obamacare

Passed in 2010, the ACA created many positive changes in the United States healthcare system. Several important changes were made to both Federal and State governments as well as the entire healthcare industry that should be acknowledged.

Because of the ACA:Young adults can now stay on their parents’ insurance plan up to age 26, regardless of whether that young adult is married.

  • Insurance companies can no longer set lifetime limits or unreasonable annual limits on the dollar value of benefits.
  • Insurance companies cannot deny coverage to anyone based on pre‐existing medical conditions, like cancer or AIDS.
  • They also cannot consider your health status when setting the price of your premiums.
  • Federal and state governments now must review annual premium increases. Insurance companies are required to justify premium increases to regulators, and to post this information on the web.
  • The ACA also included a mandate that everyone in the country should have some form of health insurance. The Act provided health insurance tax credits (subsidies) for many small businesses to help them provide insurance to their employees. Subsidies are also available to many low income people who purchase their own coverage.
  • Federal and state exchanges were established that allow people to shop for the best plans that meet their needs simply and effectively.

Now, six years after the ACA became law, the uninsured rate in the United States is at an all time low, below 10%.


Also included in the Act was a mandate that all 50 states should expand their state run Medicaid plans to provide health insurance to the country’s poor. That one component of the plan was overturned in 2012 by the Supreme Court when they ruled that it was unconstitutional for the federal government to require this action by the states. Because of generous reimbursements by the federal government, almost the entire cost of these expanded Medicaid programs was provided until 2020, when states are expected to cover 10% of the cost of these new enrollees themselves. This new reimbursement rate of 90% is far greater than it was before the ACA, which was around 60%.


cover-3Despite these positive changes, political opposition to the ACA has continued for the last six years. 19 states have refused to expand their Medicaid programs, despite decreases in the number of uninsured in states that have expanded.

My upcoming book, “Lives Lost: The True Cost of Medicaid Non-expansion” will explain more about this partisan issue and provide a historical context for understanding it. You can read more about my book and sign up for updates when it is published this fall at http://www.lives-lost.com.

Medicaid expansions in 31 states are improving access to care for the poor. Along with access, positive changes in public health are beginning to be more noticeable.

Both parties have widely differing views on how they will proceed if they take control of the country for the next four years. Elections have a direct effect on future public policy, and the issue of health care is of paramount importance to consider when deciding how to vote this November. Here’s a summary of both parties platform statements about the ACA and health care.

The Republican Platform on Health Care

Clinton, Trump pick up big wins
Donald Trump

Unsurprisingly, the Republican party position is based upon the repeal of the ACA. The real question is what they would replace it with.

The future of Medicare would be in question as they also propose a vague plan of voucher based insurance as a replacement. First proposed in Speaker of the House Paul Ryan’s failed campaign to be Vice-President four years ago, this has been shown to be an incredibly short sighted and potentially disastrous alternative to the existing Medicare program that millions of Americans have been paying into for the last 50 years.

Assuming that Donald Trump wins the election and the Republicans hold control of Congress, the most likely outcome will be the repeal of the ACA. Since simply repealing the law would remove the funding for existing Medicaid expansions, federal subsidies to individuals and businesses, and destabilize the entire health insurance industry, they would need to replace some key components with new laws and regulations. The GOP plan on how they would do this is short on details, and in some cases there is little indication what the replacement would be.

You can download and read the Republican platform position paper at https://www.gop.com/the-2016-republican-party-platform/.

Key Points From the Republican Platform on Health Care

– The Republican platform would allow people to buy insurance across state lines with little or no federal regulation. This sounds like a cost saving measure, and is billed as creating a more competitive environment amongst insurers that would lower insurance premiums. Actually, all it would do is let insurers set up businesses in states that have the least regulations. The actual way to lower premiums without affecting the quality of the insurance plan is to have insurers expand their coverage areas into states they want to sell insurance in, forcing them to negotiate contracts with hospitals and physicians in those areas.

– Their platform would limit federal spending on Medicaid by using block grants to “give states more control”. The federal money that comes to Medicaid programs now is based on the amount of care delivered by each state’s respective program. Using block grants of finite amounts not tied to spending would lead to lower federal spending, and would shift the cost of rising health care to states. This would lead to reduced Medicaid eligibility and coverage as states try to save money.

–  The Republican platform would also weaken existing protection from insurance discrimination for people with preexisting conditions. Thanks to the ACA, we already have a prohibition on insurance discrimination. Changing this would simply weaken what is in the ACA, a guaranteed access to insurance for everyone. If someone has a gap in coverage under their proposal, the insurers could deny them future coverage. This creates a loophole that would make it hard, if not impossible, for someone with cancer or AIDS to get insurance coverage if financial difficulties caused them to miss a payment or two and lose their existing coverage.

– Trump would end what Republicans call “tax discrimination against the individual purchase of insurance.” What this actually means is that they would allow people who buy insurance on their own to deduct the cost of their premiums on their taxes, which would put individual insurance on equal footing (from a tax perspective) with employer-provided coverage. This would end the ACA’s income based subsidies that currently direct the most assistance towards people with the lowest incomes.

Summary of the Republican Plan for Health Care

gopDonald Trump supports the changes in the platform, especially when it would benefit upper-income people in higher tax brackets. People with lower incomes, which would be most of the uninsured if the ACA is repealed, would not benefit from this. They are in much lower tax brackets and do not generally itemize their deductions. Trump’s plan to repeal the ACA would eliminate insurance for more than 20 million people and do nothing to help them get new insurance.

The Republican plan includes radical changes designed to force states to cut or limit enrollment in Medicaid. States that have not expanded Medicaid as of January 1, 2016 would not be eligible for ACA funding to expand. All states would have to choose between a block grant or a per capita cap that would severely limit federal reimbursement.

One of the biggest objections from Republican Governors of the 19 states that have not expanded Medicaid yet is that they do not trust the federal government to keep it’s commitment to relatively unlimited and generous reimbursement rates in the future. Yet the only politicians trying to renege on the ACA’s commitments are the Republicans in Congress and Trump. Their plan states this clearly: “… states would get broad new flexibilities such as the ability to charge reasonable enforceable premiums or offer a limited benefit package. States could also use waiting lists and enrollment caps…”

The Trump plan is also short on the details that are necessary to develop an accurate estimate of its cost to taxpayers. The Congressional Budget Office (CBO) could determine the actual future cost of the Republican plan if they provided sufficient details about how it would be implemented, but they deliberately did not do so in their platform. We have no idea whether or not what they propose will actually save any money, but we do know it will harm the poor.

Speaker of the House Paul Ryan stated, “Our proposal is like a health-care ‘backpack’ that provides every American access to financial support for an insurance plan chosen by the individual and can be taken with them job-to-job, home to start a small business or raise a family, and even into retirement years.” For anyone looking closely at their plan, the “backpack” appears to be empty, void of detail and substance.

Key Points From the Democrat Platform on Health Care

Clinton, Trump pick up big wins
Hillary Clinton

As opposed to repealing the ACA, the Democrats would continue to build on and improve it. It’s been called Obamacare 2.0, and deserves careful consideration. With Clinton’s plan the goal of having universal health care, where every person would have some form of health insurance, would come much closer to reality. Convincing the remaining states to expand Medicaid for the working poor would be a top priority as this would provide coverage for another 3,000,000 Americans. Increasing the subsidies to individuals that earn up to 400% of the Federal Poverty Level and strengthening the existing subsidies to small business would be a priority.

You can download and read the Democrat platform position paper at www.demconvention.com/platform/.

– Clinton has proposed to raise the ACA’s current income based subsidies to make insurance more affordable for people with lower incomes. She has also proposed creation of a refundable tax credit for those who have private insurance that would take effect when their out of pocket expenses relative to their incomes becomes to high. The Democrat platform also calls for an end to “surprise medical bills” by requiring more upfront transparency by providers about the actual costs of care.

– The Democrats want to create a “public option” plan, that would allow Americans to purchase Medicare as their insurer before retirement age. This would bring more healthy people into the program, and have the effect of lowering costs for the federal government and consumers.

– The Democrat plan wants to lower the high cost of prescription drugs. Monthly out-of-pocket drug costs to consumers would be capped, helping many people afford needed medications. To lower the cost to insurers, importing drugs safely manufactured in other countries would be permitted. Also, the practice of “pay for delay” deals with pharmaceutical companies that postpone the introduction of generic drugs would be ended. Medicare would finally be allowed to negotiate drug prices directly with manufacturers, something the Republicans restricted Medicare from doing when they passed the prescription drug component (Part D) in 2006.

– Democrats want expanded funding for community health centers. Clinton has proposed $40 billion in additional funding for health centers over 10 years, which would represent a substantial increase in resources. This would move the country much closer to the goal of Value Based Health Care.

Summary of the Democrat Plan for Healthcare

demDemocrats would continue to increase the number of people who have health insurance, especially the poor, with subsidies and expanded Medicaid. They would try to enhance the ability of the federal government’s purchasing power and regulations to continue to lower health care costs and reign in the high profits being made by pharmaceutical companies. They would continue protecting Americans from medical insurance discrimination and high out-of-pocket expenses.

In contrast, Republicans are focused more on controlling federal spending on health care and minimizing regulation. They want a radical shift to untested policies that would lead to more poor people without insurance and far less protection for people with pre-existing medical conditions.


Whoever wins the presidential election in November, neither side will get everything they
want. Congress passes the laws in this country, not the President. Down ballot elections might swing the Senate to the Democrats, giving Clinton more control if elected or limiting Trump’s ability to effect any of the Republican  agenda.

We can’t predict the future. But we can see what the outcomes of the directions the two parties are proposing. One party, the Democrat party, wants to move forward and build on the successes of the ACA. We can work to fix the problems that exist now using the knowledge and experience we’ve gained over the last 5 years. The Republican Party has obstructed the ACA at every opportunity, even to the point of denying their own poor the right to have health insurance via Medicaid at little cost to the states.

People’s lives are at stake in this election. Having health insurance can be a life or death matter for many people, as it gives access to preventative care and diagnostics that can detect treatable diseases. Having health insurance can mean the difference between being able to afford life saving medications and treatments, or not. In fact, in states that have not expanded Medicaid under the ACA, people are dying every year from a lack of health insurance.

Bennett editorial cartoon
Editorial Cartoon by Clay Bennett, Chattanooga Times Free Press

As a Christian, I am continually reminded of what Christ’s message for us actually is in our everyday lives. He said, “For I was hungry and you gave me food, I was thirsty and you gave me drink, I was a stranger and you welcomed me, I was naked and you clothed me, I was sick and you visited me, I was in prison and you came to me.’ Then the righteous will answer him, saying, ‘Lord, when did we see you hungry and feed you, or thirsty and give you drink? And when did we see you a stranger and welcome you, or naked and clothe you? And when did we see you sick or in prison and visit you?’ And the King will answer them, ‘Truly, I say to you, as you did it to one of the least of these my brothers, you did it to me.’ “-Matthew 25

The fact remains that the ACA is the law of the land in the United States, and has brought health insurance to over twenty million Americans. This means happier, healthier and longer lives for those people, many of whom are poor. We need to protect the gains we have made as a nation, and continue to press forward. I am certain that God calls us forward as a nation, not backward. 

The handwriting on the wall is His.
It’s up to us to read it.

About the author:

I am a Christian, a Health Care Advocate, a Blogger, and an Author living in Columbia, South Carolina. You can learn more about my advocacy work at www.fierceadvocacy.com.

You can contact me directly at fierceadvocacy@gmail.com.

Selected Sources and Further Reading

The National Physicians Alliance Foundation has an excellent set of resources on their web site if you want to take a closer look.


The Atlantic magazine ran this excellent article on the Democrat plan for healthcare.


Commonwealth Magazine reviewed the Republican healthcare platform here.


5 thoughts on “Handwriting on the Wall

  1. Gary, your dedication to studying the details of what we can expect on a subject that will errect everyone in America, but few understand the facts.
    All too often the old party line quotes are regurgitated just because it is fashionable.
    Well done.

  2. A well written and well considered consideration of our choices for the upcoming election from a knowledgeable source. Which means it will be vilified and ignored by the basket of deplorables.

  3. Great job Gary. I love 99.9% My only beef is the “Democrat platform,” rather than Democratic. It’s the invective that McCarthy used that I don’t like. Let us know when the book publishes!

    1. Thanks! As a writer, I’ve tried to decide which word is more appropriate. I decided to use Democrat as opposed to Democratic simply to avoid confusion with the other meaning of the word democratic.

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