2016: Year in Preview

The 2016 election season: Democrats to play D while GOP devises a game plan


Robert Calandra

You can expect to hear about the ACA often during the presidential election next year. What is said about it will depend, of course, on the party.

“I think health care has become a place holder for an ideological debate over the role of government,” says Michael Leavitt, the former governor of Utah and secretary of Health and Human Services in President George W. Bush’s administration. “It has become a symbol, and symbols are very important in presidential elections.”

Michael Leavitt

The ACA has become “a symbol, and symbols are very important in presidential elections,” says Michael Leavitt, former HHS Secretary under President George W. Bush. It’ll will come up. Often.

If that’s the case, then Hillary Clinton is likely to paint the ACA as a symbol of success that just needs a little fine-tuning. She has already distanced herself some from the current law by coming out against the Cadillac tax on high-priced health plans. Bernie Sanders, who voted for the ACA, is campaigning for “Medicare for All” and a single-payer system.

All 15 (or however many are still remaining when we go to press) GOP presidential candidates hold fast to the party’s “repeal and replace” position. But Leavitt thinks come September, we’ll hear less about it: “My guess is they [repeal and replace] will be used far more frequently in the primary than they will in the general,” Leavitt says.

But no matter who takes the White House, Leavitt says the winner will have to lay out a general strategy about the future of American health care.

“People genuinely and intuitively believe that the health care system needs to be fixed and they are not yet persuaded that it is,” he says.

Agreeing on an alternative to the ACA could be a challenge for the Republicans. “A third of Republicans want to eliminate the subsidies and two thirds want to reform the subsidies,” says Joel Ario, a managing director at Manatt Health Solutions and former Pennsylvania insurance commissioner under Gov. Ed Rendell, a Democrat. “They have radically different ideas.”

Yet there are some common threads to the positions that Republican candidates have staked out so far. Both Jeb Bush and Marco Rubio have, for example, called for creation of tax credits that would allow Americans to buy health coverage. Bush also wants an increase in the limits on health savings accounts, while Rubio has come out in favor of creation of high-risk pools for those with pre-existing conditions and moving Medicare to premium support.

In the past, Democrats have used any plans to change Medicare against Republicans. Whether the growing popularity of Medicare Advantage will blunt these attacks will be one of the things to watch in 2016.

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