The 2016 general election has had its fair share of twists and turns. On the Democratic side, we witnessed a titanic clash in the form of the moderate Democratic candidate, Secretary Hillary Clinton, and the more left leaning Sen. Bernie Sanders (D-Vt.). Meanwhile, the Republican camp quickly turned into an “anyone’s game” situation, out of which emerged one of the most unlikely dark horses in electoral history: Republican presidential candidate Donald Trump.
Regardless of who ends up in the Oval Office next January, this much is certain: there exists a multitude of dynamics that could result in seismic shifts within the US healthcare system.
In this blog post, we’ll focus on Amendment 69 and viability of a United States Single-Payer System and how the candidates have aligned themselves with each issue.
Amendment 69 is a ballot initiative in the sate of Colorado that, if supported by state voters, could lead to the creation of what the Denver Post refers to as “ColoradoCare” [1]. Under this single- payer system, employer-sponsored insurance and the private insurance delivery system would cease to exist, and would be replaced with a public option funded entirely by state tax revenue. This would require $25 billion in new tax revenues shared by employers and employees alike, effectively doubling the state’s current budget. It would also mean that employers and their workers would be weaned off employer-sponsored insurance plans, which could have drastic, unforeseeable implications on corporations, their employees and the overall healthcare delivery system in Colorado.
The single-payer movement was largely championed by Bernie Sanders, whose campaign had a profound impact on public opinion on the matter. Additionally, strong opposition to the Affordable Care Act from the GOP, specifically Sen. Marco Rubio of Florida, has also had the unforeseen effect of fueling support for a single-payer option. Rubio ardently attacked the Obama Administration’s “risk corridors,” which according to the Wall Street Journal, would have spread exposure among insurers in the ACA and the government during the first few years of adoption. If insurers ended up with “a healthier-than-expected pool of customers,” any surplus from premiums would go to the government, which in turn, would be distributed among insurers that experienced a deficit [2].
However, the viability of the public exchanges, as a whole, has been significantly diminished as a result of the unforeseen and systemic problem left in the wake of the failed risk corridors. Specifically, insurers such as Humana, United, Cigna and Aetna have all withdrawn, in some capacity, from offering individual ACA healthcare plans on the public exchanges due to unsustainable adverse risk. This has left public exchanges, and subsidized healthcare, the very crux of the Affordable Care Act, in a state of turmoil. Because of the resulting lack of plans, carrier competition and options for insured’s in many markets, the long-term sustainability of the Affordable Care Act, in its current structure, has been called into question, thus opening the door for proponents of a single-payer system. Now, more than half of Americans support the idea of replacing the Affordable Care Act with a single-payer system. Polls also suggest that the lion’s share of the nation’s Democratic contingency (81 percent) are in favor of a single-payer regime [3].
Nevertheless, opposition for a single-payer system has recently become much more vocal, and concerns have arisen around the impact the establishment of such a system in Colorado, and more globally, would have, particularly on tax rates, access to quality care, as well as the fundamentals of the healthcare delivery system.Not to mention, this would be the biggest expansion of government in recent times.
CLINTON
Initially opposed to the concept of a single-payer system, Clinton’s stance softened in response to the overwhelming amount of support that Sanders was able to rally during the primary. In a bid to draw more momentum from the left, Clinton proposed a public option in which Americans over the age of 55 could qualify for Medicare [4]. That said, Clinton has not advocated for “ColoradoCare.” In fact, statements from a recent batch of leaked staffer emails suggest that Clinton has avoided the issue, which some experts interpret as an indication of opposition [5]. At the moment, Amendment 69 and the single-payer notion as a whole, appear to be remnants from the former Sanders campaign more than initiatives that Clinton intends to stand behind, at least for now. Should Clinton reach the Oval Office, and there is a shake up in Congressional control, we may see the resurgence of HillaryCare, the single-payer option championed by Clinton in 1993.
TRUMP
Trump has not publically commented on Amendment 69, but the Republican nominee has historically shown zero tolerance for the implementation of a single- payer, public health care option. He has stated that he approves of the idea of mandating taxpayers to be insured, but he later contradicted that view, noting that Americans should be able to have a choice on something of that magnitude. Trump also supports the concept of creating increasing competition – which theoretically could lead to lower premium costs – by allowing carriers to sell insurance across state lines. Specifically, Trump asserts that “any vendor ought to be able to offer insurance in any state.” [6]
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