Policy Largely Absent in Presidential Debate

Growing Number of Americans Covered by Medicaid Fuels Reform Agenda in Congress

Continuing Resolution Includes Funding for Zika Virus and Opioids

Health Policy Largely Absent in Presidential Debate

On Monday, September 26, 2016, the first presidential debate between Hillary Clinton and Donald Trump was held, moderated by NBC News’ Lester Holt and focusing on themes of “Achieving Prosperity,” “Securing America,” and “America’s Direction.” While the 95 minute debate was lively, discussion of health policy was notably absent. While Clinton discussed addressing mental illness in the context of criminal justice reform, and both candidates debated gun violence, other high profile issues such as the Affordable Care Act and drug pricing were missing.

However, these topics will likely arise in the scheduled upcoming debates, particularly as November 1st, the start of open enrollment on the exchanges, approaches, along with a greater focus on premium increases and the future of the Affordable Care Act. On October 4, 2016, the Vice Presidential debate between Senator Tim Kaine and Governor Mike Pence is expected to be more policy oriented, moderated by Elaine Quijano of CBS News. Meanwhile, the next matchups between Trump and Clinton on October 9th, in a town meeting format with Martha Raddatz of ABC News and Anderson Cooper of CNN, and October 19th, returning to the format of the first debate and led by Chris Wallace of Fox News, will give both candidates ample opportunity to discuss their visions for health care. For each of these upcoming debates, the moderators have until one week before the debate to announce the topics. A potential shake-up to the debates could occur if one candidate pulls out of the remaining debates or third-party candidates rise in the polls to meet the 15 percent support threshold to be invited.

While the debate did not focus on health policy, the Kaiser Family Foundation recently published a comparison of Clinton and Trump’s positions on seven health care issues, including the Affordable Care Act, health insurance, Medicaid, Medicare, opioids, prescription drugs, women’s reproductive health, and the Zika virus. While Clinton has laid out more detailed policy proposals, the comparison still shows a clear contrast between the two candidates. While Clinton has pledged to continue President Obama’s work on the Affordable Care Act while working to improve the law, Trump has said he would repeal and replace the law, in line with the views of many Congressional Republicans. On prescription drugs, both Trump and Clinton have expressed support for allowing the importation of drugs. Clinton has also gone farther, laying out plans to create out-of-pocket limits on prescriptions to help consumers, while also addressing aspects of the pharmaceutical industry she cites as contributing to high drug prices. Finally, on Medicaid, Clinton will push for the expansion of Medicaid in all states. Trump, on the other hand, has expressed support for both turning Medicaid into a block-grant while also using the program to help Americans struggling to afford insurance.

Growing Number of Americans Covered by Medicaid Fuels Reform Agenda in Congress

Seventy-five million Americans, nearly one-quarter of all Americans, are now covered by Medicaid, according to a recent report from PwC. The report notes that the number of Americans covered by Medicaid grew from 59 million in 2013, before the expansion of Medicaid through the Affordable Care Act, which raised eligibility to 133 percent of the Federal Poverty Level, to 75 million today. The expansion of Medicaid has been an important factor in reducing the uninsured rate in the United States, which recently hit its lowest level ever at 9.1 percent in 2015, according to the Census Bureau. The potential exists for the number of Americans covered by Medicaid to continue growing, with some states still eligible for Medicaid expansion, and others potentially seeking waivers in 2017 to cover additional populations.

The increasing number of Americans receiving coverage through Medicaid will be an important focal point for proponents of Medicaid reform in the 115th Congress. The House Ways and Means Committee’s Medicaid Task Force, led by Rep. Brett Guthrie (R-KY), is expected to release a report with recommendations for reform later this year. In addition, the Children’s Health Insurance Program (CHIP), which is viewed as parallel, supplementary, or duplicative of Medicaid depending on one’s perspective, is due for reauthorization in 2017, after its funding was extended for two years in the Medicare Access and CHIP Reauthorization Act in 2015. The convergence of CHIP legislation and Medicaid reform will underpin fertile ground for reform proposals, particularly as Medicaid continues to see shifts toward managed care. In addition, the continued focus on reducing or controlling growing health care costs is of particular importance as state budgets continue to feel pressure, while at the same time the Affordable Care Act’s Medicaid expansion matching funds begin to reduce from a match of 100 percent to 90 percent between 2017 and 2020.

Continuing Resolution Includes Funding for Zika Virus and Opioids

With the start of Fiscal Year 2017 quickly approaching on October 1, 2017, Congress must pass a funding bill by Friday, September 30th in order to prevent a government shutdown and simultaneously address demands on both sides for emergency funding priorities ranging from Zika to the water crisis in Flint, MI. Leaders are working to resolve these issues within or separate from the Continuing Resolution (“CR”) expected to run through December 9, 2016. The Senate is still expected to move first, before the House. On Wednesday, the Senate advanced a CR, after both parties and chambers reached agreement over whether funding to address the Flint, MI, water crisis should be included in the CR or the Water Resources Development Act, separate legislation moving through Congress. However, should Congress not be able to reach an agreement by Friday, it is possible that Congress could advance a short-term CR while work is completed over the weekend or next week. However, many Members are eager to approve a CR to begin the final stretch of campaigning leading to November.

With that being said, the Zika virus and opioids funding included in the Senate’s CR is highly likely to be in the final package that becomes law. For the Zika virus, the bill includes $1.1 billion in funding, equal to the amount approved by the Senate earlier this year, but lower than the $1.9 billion amount requested by Senate Democrats. The money would go toward mosquito control and monitoring, vaccine development, and public health resources, as well as international aid programs through the Department of State.

For opioids, the CR builds on the Comprehensive Addiction and Recovery Act (CARA) passed earlier this year. CARA created grant programs to support addiction prevention, treatment, and recovery to begin addressing the opioid addiction crisis. The Senate CR provides $7 million in increased funding for the Department of Justice and Department of Health and Human Services to begin implementing CARA’s grant programs for the duration of the CR, through December 9th (this level of funding will amount to $37 million for the full Fiscal Year).