Health care and the 1996 presidential campaign - healthcare platforms of the Democratic, Republican, Reform Parties

Healthcare Financial Management, Nov, 1996 by Robbi-Lynn Watnik

Health care is not the high-profile issue in the 1996 presidential campaign that it was during the 1992 campaign. This may be, in part, because the passage of the Health Insurance Portability and Accountability Act this year made health care less of an issue by which the candidates could differentiate themselves. Nevertheless, Medicare, Medicaid, and other health-related programs and issues continue to loom large on the national agenda, a fact no presidential candidate or political party can ignore.

Health Care and the Democratic Party

As the incumbent, President Bill Clinton had ready access to a list of laws and regulations enacted under his watch for which he and the Democratic Party can take credit. Despite failing to enact a comprehensive healthcare reform bill, he has built a legislative track record on health care.

President Clinton authorized cost saving measures and structural changes that are expected to extend the life of the Medicare Hospital Insurance Trust Fund by three years without imposing new costs on Medicare beneficiaries. Another initiative that occurred under his watch is Operation Restore Trust, a two-year pilot program to combat healthcare fraud and abuse that has already netted $42.3 million in recovered Medicare payments and levied fines.

Also launched under the Clinton administration was Medicare Choices, a demonstration program designed to give Medicare beneficiaries in certain parts of the country a wider choice of managed care plans and to test new ways to pay for managed care. The Clinton administration also created the Foundation for Accountability, the Medicare Managed Care Quality Improvement Program, and the Medicare and Medicaid Health Plan Employer Data and Information initiative. All of these programs are designed to improve the delivery of managed healthcare services to Medicare and Medicaid beneficiaries. Of special interest to financial managers is the fact that Clinton introduced HHS regulatory reforms that are expected to eliminate 1,600 pages (23 percent) of department regulations.

The Democratic Party platform calls for expansion of these initiatives. If President Clinton is reelected, the nation could see measures taken to further strengthen the Medicare trust fund and increase Medicare managed care options to include such plans as provider-sponsored organizations (PSOs) and PPOs.

A second Clinton term could also bring attempts to maintain Medicaid benefits while increasing states' flexibility in administering the Medicaid program. Part of this flexibility would include eliminating the requirement that states obtain Federal waivers before establishing Medicaid managed care programs, providing home care, or establishing community-based services. In addition, the Democratic Party seeks to provide limited governmental assistance to Americans who are temporarily out of work to help them pay for health insurance.

Health Care and the Republican Party

Republican presidential candidate Bob Dole backs healthcare reform based on free market solutions that do not include price controls, mandates, or taxes. Notwithstanding his vote against the creation of the Medicare program, he asserts that Medicare must be saved and has championed efforts to deal with the Medicare funding crisis. Prior to leaving the U.S. Senate, Dole introduced legislation to create a blue-ribbon bipartisan commission charged with finding long-term solutions to Medicare's problems. Dole has promised to support Medicare beneficiaries' rights to choose the coverage that best meets their needs. Dole and the Republican Party also stand behind further lowering Medicare spending.

Dole stresses the need for Medicaid reform. He supports the National Governor's Association's proposal to overhaul the system by transferring more control over the Medicaid program to the states. The Republicans would also like to give the states more discretionary powers to "weed out substandard providers" and remove excess costs from the healthcare delivery system. Moreover, they would like low-income Americans to have access to managed care programs and medical savings accounts.

Health Care and the Reform Party

Among the political alternatives to the Republican and Democratic parties is the newly formed Reform Party and its presidential candidate Ross Perot, the Texas businessman who captured 19 percent of the popular vote in the 1992 presidential election. Since Perot has never held public office, he and his party have no legislative track record to leverage in forwarding his candidacy. The Reform Party has not developed a formal party platform, relying instead on Perot to elaborate on the "Principles of Reform" created at the 1995 United We Stand America National Conference. Perot outlined his thoughts on health care in a book and has issued a broad policy statement that stresses the need to put patients first.

Perot does not advocate a centralized healthcare system. Instead, he would pilot-test plans in each state to allow government leaders assisted by experts in the field to pick the plan that works best for their region. Most of Perot's other priorities have essentially been accomplished with the passage of the Health Insurance Portability and Accountability Act.