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* * *

While healthcare policy was not as central to the 2016 presidential election as it had been in years prior, one issue rose to prominence: prescription drug prices.[1] A poll by the Kaiser Family Foundation found that prescription drug prices also ranked highest among voters' healthcare-related concerns.[2]

In healthcare policy on the state level, candidates debated the expansion of Medicaid programs as provided for under the Patient Protection and Affordable Care Act.[3]

Republican candidates in 2016 generally opposed the Affordable Care Act and favored expanding the use of health savings accounts and lessening state regulations. Democratic candidates generally supported expanding upon the Affordable Care Act, and some called for a completely new single-payer system.

HIGHLIGHTS

* Major healthcare policy issues in the 2016 elections included prescription drug prices, the Affordable Care Act, Medicaid expansion, health insurance exchanges, and spending and costs.

* Ballotpedia tracked 29 healthcare-related ballot measures in 2016, six of which were certified to appear before voters.

This page summarizes some of the key healthcare policy issues that were debated in 2016, as well as the stances of political parties and presidential candidates on those issues. In addition, this page identifies relevant state and local ballot measures. Click on the tabs below to learn more.

## Contents

* 1 Major issues
* 1.1 Prescription drug prices
* 1.2 Affordable Care Act
* 1.3 Medicaid expansion
* 1.4 Health insurance exchanges
* 1.5 Healthcare spending and costs
* 2 National races
* 2.1 Democratic Party
* 2.1.1 Platform
* 2.1.2 Hillary Clinton on healthcare
* 2.2 Republican Party
* 2.2.1 Platform
* 2.2.2 Donald Trump on healthcare
* 2.3 Green Party
* 2.3.1 Jill Stein on healthcare
* 2.4 Libertarian Party
* 2.4.1 Gary Johnson on healthcare
* 3 State issues
* 3.1 Common state issues
* 3.1.1 Medicaid expansion
* 3.1.2 Health insurance exchanges
* 3.1.3 Opioid crisis
* 4 Ballot measures
* 4.1 Healthcare ballot measures
* 4.2 Certified healthcare ballot measures
* 4.3 Proposed healthcare ballot measures
* 4.4 See also
* 4.5 Footnotes

# Major issues[edit]

* ON THIS TAB:
* Drug prices
* Affordable Care Act
* Medicaid expansion
* Health exchanges
* Spending & costs

### Prescription drug prices[edit]

To learn more, see Ballotpedia's full page on prescription drug prices.

In September 2015, Turing Pharmaceuticals raised the price of Daraprim, a generic drug for parasitic infections, by 5,556%, bringing greater attention to the price of prescription drugs. In August 2016, reports began circulating that the price of EpiPen autoinjectors, manufactured by Mylan, had increased by 500% over the previous decade to $608 for a pack of two.

In the Kaiser Family Foundation's October 2015 Health Tracking Poll, 77% of individuals polled said the top healthcare priority for the federal government should be "[m]aking sure that high-cost drugs for chronic conditions are affordable for those who need them." Ranked as the second-highest priority was "[g]overnment action to lower prescription drug prices."[2]

Presidential candidates from both major parties discussed the issue during the primary season, and each of their nominees commented on the issue while campaigning. In his seven-point healthcare plan, Donald Trump (R) stated that he would allow more overseas drug providers to sell in the United States through lowered regulatory barriers. Hillary Clinton (D), responding to Turing's and Mylan's price hikes, released a plan to import drugs from developed countries and penalize pharmaceutical manufacturers for "unjustified" price increases. Both candidates supported allowing Medicare to negotiate drug prices, which the agency was prohibited from doing.[4][5][6]

Meanwhile, lawsuits were filed in at least six states--Colorado, Indiana, Massachusetts, Minnesota, Pennsylvania and Washington--over government policies that restricted coverage of costly hepatitis C drugs to the sickest patients. Drugs for complex conditions such as hepatitis C are called specialty drugs and made up 32% of drug spending while accounting for just 1% of all drugs prescribed in 2014. They also comprised a growing portion of new drugs approved by the Food and Drug Administration (FDA); each year between 2010 and 2014, over half of the new drugs approved by the FDA were specialty drugs.[7]

Drug prices also prompted at least 13 states to introduce "legislation that would require pharmaceutical companies to justify their prices by disclosing how much they spend on research, manufacturing and marketing" during the 2015 and 2016 sessions. Some of the measures would have applied only to drugs above a certain cost threshold. According to the Pew Charitable Trusts, bills were filed in California, Colorado, Massachusetts, Michigan, New York, North Carolina, Oregon, Pennsylvania, Tennessee, Virginia and Washington. A bill was also filed in Minnesota, and Vermont became the first state to enact such legislation in June 2016.[8][9]

### Affordable Care Act[edit]

The number of uninsured Americans dropped after the Affordable Care Act, commonly referred to as Obamacare, became law on March 23, 2010. As of November 2016, 11% of Americans remained uninsured compared to 16% in 2010. Despite this success, health insurers were concerned about Obamacare's financial sustainability and fewer participants were reporting that the law had helped their family. After six years, more than half of Americans said Obamacare has had no effect on them or their family.[10]

The nonpartisan Henry J. Kaiser Family Foundation conducted multiple polls on opinions regarding Obamacare. In an August 2016 poll, 40% of participants viewed the law favorably while 42% viewed it unfavorably. Additionally, a poll from January 2015 showed that 50% of participants felt that it was important to continue the debate over Obamacare, while 45% of participants felt the debate had gone far enough and the country should focus on other issues. Voters who wanted more debate over Obamacare were more likely to be opposed to the legislation. Those who wanted to focus more on other issues were evenly split in their support of Obamacare.[11][12]

According to the Congressional Research Service, as of January 2016, the U.S. House of Representatives had voted to alter, defund, delay, or repeal portions of the Affordable Care Act in some way 59 times since it was enacted. Eighteen of these measures were ultimately enacted, and four would have repealed the law in its entirety had they been enacted. Republicans generally expressed support for repealing the law, while Democrats preferred to build onto and expand the Affordable Care Act.[13]

On June 22, Republicans in the U.S. House of Representatives released a white paper outlining a healthcare plan to serve as an alternative to Obamacare. The plan proposed retaining some aspects of the law, such as the restriction against insurance companies denying individuals with preexisting conditions, and allowing states that had expanded their Medicaid programs to maintain the expansions while prohibiting any new states from expanding. The plan also proposed a tax credit to purchase insurance for those without employer-sponsored coverage, allow the sale of insurance across state lines, expand the use of health savings accounts, and provide block grants to states for administering Medicaid. While the proposal was not a formal piece of legislation, House Speaker Paul Ryan (R) said that it represented a "first-time-in-six-years consensus by the Republicans in the House on what we replace Obamacare with." Many of the policies put forward in the paper were adopted as part of the Republican Party platform for 2016.[14]

### Medicaid expansion[edit]

Watch Ballotpedia's webinar on healthcare policy conflicts in the 2016 election

Medicaid expansion continued to be a big issue at the state level in 2016. The Affordable Care Act allowed states to expand their Medicaid programs to cover all individuals with incomes at or below 138% of the federal poverty level. Whether to expand the program, and how to do so, was still a heavily debated issue for states, even in some that approved the expansion. In some states, like Kentucky, officials that were newly elected in 2015 looked to repeal or change the terms of their expansion. In others, such as Alabama, new governors sought to persuade a skeptical legislature to approve an expansion.

Decisions to expand the program had been made either by state legislatures or, in at least four states, by governors via executive order. The partisan composition of these offices impacted decisions on expansion. In addition, the Pew Charitable Trusts speculated that the party affiliation of the next president could affect state Medicaid expansions--a Republican administration may be more likely to approve proposals to expand Medicaid using an alternative method, such as providing assistance for enrollees to purchase a health plan on the health insurance exchanges.[15][16][17]

As of November 2016, 31 states had expanded Medicaid, while 19 states had not. Of those 19 states, 17 were governed by Republican trifectas. A trifecta occurs when one political party controls a state's governorship, senate, and house. Historically, of the 25 states that expanded Medicaid prior to 2014, 13 were governed by Democratic trifectas, while eight were under divided control and four had Republican trifectas.[18]

Between 2014 and 2016, state partisan control shifted, and as of November 2016, there were seven Democratic trifectas and 23 Republican trifectas. The remaining 20 states were under divided control. The maps below depict the status of state Medicaid expansions and state government trifectas as of November 2016. Hover over the maps for more information.

### Health insurance exchanges[edit]

To learn more about these issues in detail, see Ballotpedia's full page on the health insurance exchange issues.

* * *

* * *

Healthcare policy in the U.S.
Obamacare overview
Obamacare lawsuits
Medicare and Medicaid
Healthcare statistics

Obamacare glossary • Effect of Obamacare • Centers for Medicare and Medicaid Services

Several events occurred in 2015 and 2016 that led some to question the stability and sustainability of the Affordable Care Act (ACA) health insurance exchanges:

* Over half of the nonprofit insurance co-ops established under the law, which sold plans on the exchanges, had closed by October 2016.
* Three major nationwide insurers scaled back their presence on the exchanges for 2017.
* Insurers raised premium rates for benchmark plans sold on the exchanges by 25% for 2017.

The health insurance exchanges were created under the ACA to serve as a platform for individuals without employer-sponsored insurance to browse and purchase plans. The law also provided for the establishment of insurance co-ops to compete with larger insurers on the exchanges. Twenty-three co-ops were created under the law, but many were in a precarious financial position after their first year. Policy analysts primarily attributed these early financial struggles to premiums that were set too low, benefits that were too generous, and enrollment that grew too quickly. By the end of 2015, half had been deemed insolvent by state regulators and closed. Five others closed in 2016, leaving six in operation by October.[19][20][21][22]

In addition to the co-ops, many other insurers lost money on their exchange plans—two-thirds of those participating in the exchanges were unprofitable in 2014, according to the Commonwealth Fund. During 2016, three major insurers—UnitedHealthcare, Humana, and Aetna—announced intentions to withdraw from most exchanges in 2017 due to their losses. Due to these exits and other exits of smaller statewide insurers, consulting firm Avalere found that about 36% of ACA markets would have just one carrier offering plans in 2017.[23][24]

Insurers nationwide also requested large premium increases for 2017, which they said were necessary to continue to pay medical claims for enrollees who were unhealthier than expected. It was estimated that nationwide, insurers selling plans in the individual market requested an average 24.6% rate increase. This figure included premiums for plans sold both on and off the exchanges. On October 25, 2016, the U.S. Department of Health and Human Services announced that in the 38 states using the Healthcare.gov platform, premium rates for benchmark plans would rise by an average of 25% in 2017. These increases were attributed to rising medical costs, the end of the transitional reinsurance program, and a pool of enrollees who were sicker than expected.[25][26][27]

While some argued that these events showed that the ACA's insurance model was unsustainable, others argued that the events were part of an adjustment period as insurers learned the new individual market.[28]

### Healthcare spending and costs[edit]

Healthcare spending as a percentage of gross state or gross domestic product over time. Massachusetts and Utah are included for context.

Although healthcare spending rose at a slower rate between 2008 and 2013 than during the decade before, in 2015 and 2016 there was some evidence that the pace was picking up again. Healthcare spending grew by 4.5% in 2014, and was expected to grow by about 5% annually through 2024. Additionally, according to Drew Altman of the Henry J. Kaiser Family Foundation, overall health spending was 7.3% higher in the first quarter of 2015 than the same timeframe a year prior. Much of this increase was caused by a greater use of healthcare services by the newly insured under the Affordable Care Act (ACA). Healthcare spending represented 17.4% of the gross domestic product in 2014; healthcare spending was projected to reach 19.6% of GDP in 2024 if it continued to increase at the same rate.[29][30][31]

Additionally, a March 2016 poll by the Henry J. Kaiser Family Foundation found that healthcare costs (what each person pays for healthcare) were a top concern for voters who said healthcare was an important issue to them. The poll also found that among the uninsured, 48% did not have health insurance because of the cost. While estimates of premium increases varied widely, most found some sort of increase for individual plans on the health insurance exchanges from 2015 to 2016, with many states seeing double digit increases in rates. Additionally, out-of-pocket costs for consumers such as deductibles were rising faster than premiums and wages for both employer-sponsored and individual plans.[32][33]

Increases in healthcare spending and costs prompted states to introduce numerous measures with various approaches modifying how healthcare was delivered and paid for. Most of these efforts centered on data collection in the form of all-payer claims databases, price transparency, and changes to Medicaid payment structures. Other states took more active approaches. Maryland, which had already been engaged in hospital price setting, began in 2014 setting global budgets for hospitals that covered every service provided. Massachusetts began setting goals to constrain healthcare cost growth to the growth in the state's gross state product. Since the ACA's major reforms had gone into effect, states, insurers, and providers were under greater pressure to hold down costs.[34][35][36]

Back to top↑

# National races[edit]

* ON THIS TAB:
* Democratic Party
* Platform
* Clinton on healthcare
* Republican Party
* Platform
* Trump on healthcare
* Green Party
* Stein on healthcare
* Libertarian Party
* Johnson on healthcare

###  Democratic Party[edit]

Hillary Clinton, the Democratic nominee in 2016, stated that she supported Obamacare and would have liked to expand it in ways such as increasing the advanced premium tax credits available to individuals and families and implementing a "public option" to compete with private plans. Clinton described healthcare as a basic human right. She introduced a plan in September 2015 for lowering prescription drug costs, referring to increases in the prices of pharmaceuticals as price gouging. Clinton's plan would have imposed a $250 monthly cap on prescription drugs for patients with chronic or serious health conditions and allowed patients to buy prescription drugs from Canada.[37]

#### Platform[edit]

The Democratic Party officially adopted its 2016 platform at the Democratic National Convention. The platform called for universal access to healthcare and stated that healthcare is a right. As part of this plan, the platform proposed creating a public healthcare option to compete with private insurers, allowing individuals over the age of 55 to opt-in to Medicare, and repealing the Affordable Care Act's excise tax on high-cost health insurance plans.[38]

A central component of the platform was the cost of prescription drugs. The platform proposed prohibiting business deals in which the maker of a brand-name drug pays another manufacturer to delay its release of a generic copy. The platform also called for allowing pharmaceuticals to be imported from Canada and allowing Medicare to negotiate drug prices. Under the platform, the party would have also increased funding for the National Institutes of Health, provided greater funding for substance abuse treatment, and supported the repeal of the Hyde Amendment, which prohibits the use of federal funds for abortion services.[38]

The 2016 Democratic Party Platform on healthcare

| “  | Ensure the Health and Safety of All Americans

Democrats have been fighting to secure universal health care for the American people for generations, and we are proud to be the party that passed Medicare, Medicaid, and the Affordable Care Act (ACA). Being stronger together means finally achieving that goal. We are going to fight to make sure every American has access to quality, affordable health care. We will tackle the problems that remain in our health care system, including cracking down on runaway prescription drug prices and addressing mental health with the same seriousness that we treat physical health. We will fight Republican efforts to roll back the clock on women’s health and reproductive rights, and stand up for Planned Parenthood. And we will tackle the epidemics of substance abuse and gun violence, which each claim tens of thousands of lives every year.

Securing Universal Health Care
Democrats believe that health care is a right, not a privilege, and our health care system should put people before profits. Thanks to the hard work of President Obama and Democrats in Congress, we took a critically important step toward the goal of universal health care by passing the Affordable Care Act, which has covered 20 million more Americans and ensured millions more will never be denied coverage because of a pre-existing condition. Democrats will never falter in our generations-long fight to guarantee health care as a fundamental right for every American. As part of that guarantee, Americans should be able to access public coverage through a public option, and those over 55 should be able to opt in to Medicare. Democrats will empower the states, which are the true laboratories of democracy, to use innovation waivers under the ACA to develop unique locally tailored approaches to health coverage. This will include removing barriers to states which seek to experiment with plans to ensure universal health care to every person in their state. By contrast, Donald Trump wants to repeal the ACA, leaving tens of millions of Americans without coverage.

For too many of us, health care costs are still too high, even for those with insurance. And medical debt is a problem for far too many working families, with one-quarter of Americans reporting that they or someone in their household had problems or an inability to pay medical bills in the past year. Democrats will also work to end surprise billing and other practices that lead to out-of-control medical debt that place an unconscionable economic strain on American households. We will repeal the excise tax on high-cost health insurance and find revenue to offset it because we need to contain the long-term growth of health care costs, but should not risk passing on too much of the burden to workers. Democrats will keep costs down by making premiums more affordable, reducing out-of-pocket expenses, and capping prescription drug costs. And we will fight against insurers trying to impose excessive premium increases. Democrats will fight any attempts by Republicans in Congress to privatize, voucherize, or “phase out” Medicare as we know it. And we will oppose Republican plans to slash funding and block grant Medicaid and SNAP, which would harm millions of Americans.

We will keep fighting until the ACA’s Medicaid expansion has been adopted in every state. Nineteen states have not yet expanded Medicaid. This means that millions of low-income Americans still lack health insurance and are not getting the care they need. Additionally, health care providers, clinics, hospitals, and taxpayers are footing a higher bill when people without insurance visit expensive emergency rooms.

Democrats believe your zip code or census tract should not be a predictor of your health, which is why we will make health equity a central part of our commitment to revitalizing communities left behind. Democrats believe that all health care services should be culturally and linguistically appropriate, and that neither fear nor immigration status should be barriers that impede health care access.

Supporting Community Health Centers
We must renew and expand our commitment to Community Health Centers, as well as community mental health centers and family planning centers. These health centers provide critically important, community-based prevention and treatment in underserved communities, prevent unnecessary and expensive trips to emergency rooms, and are essential to the successful implementation of the ACA. We will fight for a comprehensive system of primary health care, including dental, mental health care, and low-cost prescription drugs by doubling of funding for federally qualified community health centers over the next decade, which currently serve 25 million people.

Democrats also know that one of the key ingredients to the success of these health centers is a well-supported and qualified workforce in community-based settings. We will fight to train and support this workforce, encourage providers to work with underserved populations through the National Health Service Corps, and create a comprehensive strategy to increase the pool of primary health care professionals.

Reducing Prescription Drug Costs
It is unacceptable that the United States pays, by far, the highest prices in the world for prescription drugs and that too many Americans between the ages of 18 and 64 cannot afford to fill their prescriptions. A lifesaving drug is no good if it is unaffordable to the very people who need it most. And many drug companies are spending more on advertising than on research. The largest pharmaceutical companies are making billions of dollars per year in profits at higher margins compared to other industries while many stash their profits in offshore tax havens.

Meanwhile, they charge Americans thousands of dollars for new drugs—often at much higher costs than in other developed nations. Democrats are committed to investing in the research, development, and innovation that creates lifesaving drugs and lowers overall health costs, but the profiteering of pharmaceutical companies is simply unacceptable.

We will crack down on price gouging by drug companies and cap the amount Americans have to pay out-of-pocket every month on prescription drugs. We will prohibit anti-competitive “pay for delay” deals that keep generic drugs off the market, and we will allow individuals, pharmacists, and wholesalers to import prescription drugs from licensed pharmacies in Canada and other countries with appropriate safety protections. Democrats will also fight to make sure that Medicare will negotiate lower prices with drug manufacturers.

Enabling Cutting-Edge Medical Research
Democrats believe we must accelerate the pace of medical progress, ensuring that we invest more in our scientists and give them the resources they need to invigorate our fundamental studies in the life sciences in a growing, stable, and predictable way. We must make progress against the full range of diseases, including Alzheimer’s, HIV and AIDS, cancer, and other diseases, especially chronic ones. We recognize the critical importance of a fully-funded National Institutes of Health to accelerate the pace of medical progress.

Combating Drug and Alcohol Addiction
We must confront the epidemic of drug and alcohol addiction, specifically the opioid crisis and other drugs plaguing our communities, by vastly expanding access to prevention and treatment, supporting recovery, helping community organizations, and promoting better practices by prescribers. The Democratic Party is committed to assisting the estimated 20 million people struggling with addiction in this country to find and sustain healthy lives by encouraging full recovery and integration into society and working to remove common barriers to gainful employment, housing, and education. We will continue to fight to expand access to care for addiction services, and ensure that insurance coverage is equal to that for any other health conditions. We think it is time for the Department of Health and Human Services (HHS), the Department of Labor, and state regulatory agencies to fully implement the protections of the Mental Health Parity and Addictions Equity Act of 2008—which means that American medical insurers, including the federal government, will need to disclose how they make their medical management decisions.

We should also do more to educate our youth, as well as their families, teachers, coaches, mentors, and friends, to intervene early to prevent drug and alcohol abuse and addiction. We should help state and local leaders establish evidence-based, age-appropriate, and locally-tailored prevention programs. These programs include school-based drug education programs that have been shown to have meaningful effects on risky behavior; community-based peer mentorship and leadership programs; and after-school activities that deter drug use and encourage life skills.

Treating Mental Health
We must treat mental health issues with the same care and seriousness that we treat issues of physical health, support a robust mental health workforce, and promote better integration of the behavioral and general health care systems. Recognizing that maintaining good mental health is critical to all people, including young people’s health and development, we will work with health professionals to ensure that all children have access to mental health care. We must also expand community-based treatment for substance abuse disorders and mental health conditions and fully enforce our parity law. And we should create a national initiative around suicide prevention across the lifespan—to move toward the HHS-promoted Zero Suicide commitment.

Supporting Those Living with Autism and their Families
Democrats believe that our country must make supporting the millions of individuals with autism and those diagnosed in the future and their families a priority. We will conduct a nationwide early screening outreach campaign to ensure that all children, and in particular children from underserved backgrounds, can get screened for autism. We will expand services and support for adults and individuals transitioning into adulthood, including employment and housing assistance. And we will push states to require health insurance coverage for autism services in private insurance plans as well as state marketplaces so that people with autism are not denied care.[38][39]

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#### Hillary Clinton on healthcare[edit]

See also: Hillary Clinton presidential campaign, 2016

* In response to reports that insurance premiums would rise an average of 22 percent in 2017 under the Affordable Care Act (ACA), Clinton campaign spokesperson Julie Wood released a statement offering Clinton's continued support for the healthcare program on October 25, 2016. "There's a clear choice in this election: either we're going to help American families and tackle health care cost issues, or we're going to throw 20 million people off their coverage and let the insurance companies write the rules again. Hillary Clinton wants to build on the progress we've made and fix what's broken, while Donald Trump would rip up the ACA, reverse the progress we have made and start this fight all over again," she said.[40]

* Clinton announced a mental health plan on her campaign website on August 29, 2016. A statement from Clinton’s campaign read, “Recognizing that nearly a fifth of all adults in the United States — more than 40 million people — are coping with a mental health problem, Hillary’s plan will integrate our mental and physical health care systems. Her goal is that within her time in office, Americans will no longer separate mental health from physical health when it comes to access to care or quality of treatment. Hillary has been talking about mental health policy throughout her campaign, since hearing directly from American parents, students, veterans, nurses, and police officers about how these challenges keep them up at night.”[41]

* In a statement on August 24, 2016, Clinton called on the pharmaceutical company Mylan, which makes EpiPens, to reduce their product’s cost after reports surfaced that the price of EpiPens had increased by 400 percent in recent years. “That's outrageous — and it's just the latest troubling example of a company taking advantage of its consumers. I believe that our pharmaceutical and biotech industries can be an incredible source of American innovation, giving us revolutionary treatments for debilitating diseases. But it's wrong when drug companies put profits ahead of patients, raising prices without justifying the value behind them,” said Clinton.[42]

* At the Borinquen Medical Center in Miami, Florida, on August 9, 2016, Clinton called on members of Congress to return from recess and to pass funding to fight the spread of the Zika virus. Florida Gov. Rick Scott announced shortly before Clinton’s remarks that the 21st case of “locally transmitted Zika” had been confirmed in South Florida. Clinton said, “I am very disappointed that the Congress went on recess before actually agreeing on what they would do to put the resources into this fight, and I really am hoping that they will pay attention. In fact, I would very much urge the leadership of Congress to call people back for a special session and get a bill passed.”[43]

* Clinton announced in a statement on July 9, 2016, a few changes to her healthcare platform, including offering a public-option insurance plan and allowing Americans to enroll in Medicare when they turn 55. According to the statement, Clinton affirmed “her commitment to give Americans in every state the choice of a public-option insurance plan, something she has supported during this campaign and going back to her 2008 presidential campaign.”[44]

###  Republican Party[edit]

At the eighth Republican presidential primary debate on February 6, 2016, Donald Trump voiced support for repealing and replacing Obamacare, stating that insurance companies were "getting rich on Obamacare." He also advocated for reducing barriers to the interstate sale of health insurance and expanding the use of health savings accounts. In September 2013, Trump called Obamacare "a total disaster" and stated it "will shut down this country."[45][46]

On March 2, 2016, Trump released a seven-point plan for healthcare reform, which he described as based on "free market principles." He stated that he would repeal Obamacare, reduce barriers to the interstate sale of health insurance, institute a full tax deduction for insurance premium payments for individuals, make health savings accounts inheritable, require price transparency for healthcare services, provide Medicaid funding to states in the form of block grants, and allow for more overseas drug providers through lowered regulatory barriers. Trump added that enforcing immigration laws could reduce healthcare costs.[47]

#### Platform[edit]

The Republican Party officially adopted its 2016 platform at the Republican National Convention. In the segments addressing healthcare, the platform called for repealing the Affordable Care Act (ACA). In place of the ACA, the platform proposed funding Medicaid through block grants to states, allowing individuals and small employers to form groups for purchasing health coverage, making health insurance tax-deductible for consumers, and allowing insurers to sell plans across state lines. However, the platform kept some popular provisions of the ACA, such as prohibiting the denial of coverage to those with pre-existing conditions.[48]

The platform also called for capping non-economic damages in medical malpractice lawsuits, banning human cloning, and expanding funding for stem cell research, with the caveat that such research should not involve the "destruction of embryonic human life." Finally, the platform proposed reforming the Food and Drug Administration--though offered few details on specific changes the party would make to the agency--and voiced support for state-level right-to-try laws.[48]

The 2016 Republican Party Platform on healthcare

| “  | Restoring Patient Control and Preserving Quality in Healthcare

Any honest agenda for improving healthcare must start with repeal of the dishonestly named Affordable Care Act of 2010: Obamacare. It weighs like the dead hand of the past upon American medicine. It imposed a Euro-style bureaucracy to manage its unworkable, budget-busting, conflicting provisions. It has driven up prices for all consumers. Their insurance premiums have dramatically increased while their deductibles have risen about eight times faster than wages in the last ten years. It drove up drug prices by levying a $27 billion tax on manufacturers and importers and, through mandated price cuts for drugs under Medicare and Medicaid, forced pharmaceutical companies to raise prices for everyone else. Its “silver plans,” the most common option on the government insurance exchanges, limit people’s access to their own doctor through narrow networks and restrict drug coverage, forcing many patients to pay for extremely costly medicines for their chronic diseases.

We agree with the four dissenting judges of the Supreme Court: “In our view, the entire Act before us is invalid in its entirety.” It must be removed and replaced with an approach based on genuine competition, patient choice, excellent care, wellness, and timely access to treatment. To that end, a Republican president, on the first day in office, will use legitimate waiver authority under the law to halt its advance and then, with the unanimous support of Congressional Republicans, will sign its repeal. The Supreme Court upheld Obamacare based on Congress’ power to tax. It is time to repeal Obamacare and give America a much-needed tax cut.

In its place we must combine what worked best in the past with changes needed for the future. We must recover the traditional patient-physician relationship based on mutual trust, informed consent, and confidentiality. To simplify the system for both patients and providers, we will reduce mandates and enable insurers and providers of care to increase healthcare options and contain costs. Our goal is to ensure that all Americans have improved access to affordable, high-quality healthcare, including those struggling with mental illness.

We will return to the states their historic role of regulating local insurance markets, limit federal requirements on both private insurance and Medicaid, and call on state officials to reconsider the costly medical mandates, imposed under their own laws, that price millions of low-income families out of the insurance market. To guarantee first-rate care for the needy, we propose to block grant Medicaid and other payments and to assist all patients, including those with pre-existing conditions, to obtain coverage in a robust consumer market. Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and wellbeing of women, and we stand firmly against it.

To ensure vigorous competition in healthcare, and because cost-awareness is the best guard against over-utilization, we will promote price transparency so consumers can know the cost of treatments before they agree to them. We will empower individuals and small businesses to form purchasing pools in order to expand coverage to the uninsured. We believe that individuals with preexisting conditions who maintain continuous coverage should be protected from discrimination. We applaud the advance of technology in electronic medical records while affirming patient privacy and ownership of personal health information.

Consumer choice is the most powerful factor in healthcare reform. Today’s highly mobile workforce needs portability of insurance coverage that can go with them from job to job. The need to maintain coverage should not dictate where families have to live and work. We propose to end tax discrimination against the individual purchase of insurance and allow consumers to buy insurance across state lines. In light of that, we propose repealing the 1945 McCarran-Ferguson Act which protects insurance companies from anti-trust litigation. We look to the growth of Health Savings Accounts and Health Reimbursement Accounts that empower patients and advance choice in healthcare.

Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and will implement programs to protect against elder abuse.

Protecting Individual Conscience in Healthcare
America’s healthcare professionals should not be forced to choose between following their faith and practicing their profession. We respect the rights of conscience of healthcare professionals, doctors, nurses, pharmacists, and organizations, especially the faith-based groups which provide a major portion of care for the nation and the needy. We support the ability of all organizations to provide, purchase, or enroll in healthcare coverage consistent with their religious, moral, or ethical convictions without discrimination or penalty.

We support the right of parents to determine the proper medical treatment and therapy for their minor children. We support the right of parents to consent to medical treatment for their minor children and urge enactment of legislation that would require parental consent for their daughter to be transported across state lines for abortion. Providers should not be permitted to unilaterally withhold services because a patient’s life is deemed not worth living. American taxpayers should not be forced to fund abortion. As Democrats abandon this four decade-old bipartisan consensus, we call for codification of the Hyde Amendment and its application across the government, including Obamacare. We call for a permanent ban on federal funding and subsidies for abortion and healthcare plans that include abortion coverage.

Better Care and Lower Costs: Tort Reform
Medical malpractice lawsuits have ballooned the cost of healthcare for everyone by forcing physicians to practice defensive medicine through tests and treatments which otherwise might be optional. Rural America is especially affected as obstetricians, surgeons, and other providers move to urban settings or retire in the face of escalating insurance premiums. Many Republican Governors have advanced the legal reforms necessary to reverse that trend. We support state and federal legislation to cap non-economic damages in medical malpractice lawsuits, thereby relieving conscientious providers of burdens that are not rightly theirs and addressing a serious cause of higher medical bills.

Advancing Research and Development in Healthcare
American medicine is poised to enter a new era of technological advance. Federal and private investment in basic and applied biomedical research holds enormous promise, especially with diseases and disorders like autism, Alzheimer’s, and Parkinson’s. Just as we today take for granted wonders that seemed impossible a few decades ago — MRIs and CAT scans, robotic surgery, and in utero treatment — patients a decade hence will have care and treatment that will make much of today’s medicine look primitive. Modern miracles involving genetics, the immune system, cures for deadly diseases, and more are in the research pipeline. This is the consequence of marrying significant investment, both public and private, with the world’s best talent, a formula that has for a century given the American people the world’s best healthcare. We are determined that it should continue to do so, especially as we confront new dangers like Ebola, Zika, Chikungunya, and antibiotic-resistant pathogens.

To continue our headway against breast and prostate cancer, diabetes, and other killers, research must consider the needs of formerly neglected demographic groups. We call for expanded support for the stem cell research that now offers the greatest hope for many afflictions — through adult stem cells, umbilical cord blood, and cells reprogrammed into pluripotent stem cells — without the destruction of embryonic human life. We urge a ban on human cloning for research or reproduction, and a ban on the creation of, or experimentation on, human embryos for research. We applaud Congress’ ban on the FDA approval of research involving three-parent embryos. We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Putting Patients First: Reforming the FDA
The United States has led life sciences and medical innovation for decades, bringing millions of high-paying jobs to our country and helping Americans and people around the world live longer, healthier lives. Unfortunately, the continuously increasing burden of governmental regulation and red tape is taking its toll on our innovative companies, and their pipeline of new life-saving devices and drugs to our nation’s patients is slowing and diminishing. The FDA has slowly but relentlessly changed into an agency that more and more puts the public health at risk by delaying, chilling, and killing the development of new devices, drugs and biologics that can promote our lives and our health. The FDA needs leadership that can reform the agency for our century and fix the lack of predictability, consistency, transparency and efficiency at the agency. The FDA needs to return to its traditional emphasis on hard science and approving new breakthrough medicines, rather than divert its attention and consume its resources trying to overregulate electronic health records or vaping. We pledge to restore the FDA to its position as the premier scientific health agency, focused on both promoting and protecting the public health in equal measure, so we can ensure that Americans live longer, healthier lives, that the United States remains the world leader in life sciences and medical innovation, that millions of high-paying, cutting-edge device and drug jobs stay in the United States, that U.S. patients benefit first and most from new devices and drugs, and that the FDA no longer wastes U.S. taxpayer and innovators’ resources through bureaucratic red tape and legal uncertainty. We commend those states that have passed Right to Try legislation, allowing terminally ill patients the right to try investigational medicines not yet approved by the FDA. We urge Congress to pass federal legislation to give all Americans with terminal illnesses the right to try.[48][39]

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#### Donald Trump on healthcare[edit]

See also: Donald Trump presidential campaign, 2016

* In a speech in Pennsylvania on November 1, 2016, Trump said he would call for a special session of Congress to repeal the Affordable Care Act if elected president. “When we win on November 8th and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare. Have to do it. I will ask Congress to convene a special session so we can repeal and replace. And it will be such an honor for me, for you, and for everybody in this country because Obamacare has to be replaced. And we will do it and we will do it very, very quickly. It is a catastrophe,” said Trump.[49]

* In an interview on September 15, 2016, Trump said that birth control “should not be done by prescription.” He said, “I think what we have in birth control is, you know, when you have to get a prescription, that’s a pretty tough something to climb. And I would say it should not be a prescription, it should not be done by prescription. … you have women that just aren’t able to go get a prescription. So and more and more people are coming out and saying that, but I am not in favor of prescription for birth control.”[50]

* On March 2, 2016, Trump released a seven-point plan for healthcare reform, which he described as based on "free market principles." He stated that he would repeal Obamacare, reduce barriers to the interstate sale of health insurance, institute a full tax deduction for insurance premium payments for individuals, make Health Saving Accounts inheritable, require price transparency, block-grant Medicaid to the states, and allow for more overseas drug providers through lowered regulatory barriers. Trump added that enforcing immigration laws could reduce healthcare costs.[51]

* At the eighth Republican presidential primary debate on February 6, 2016, Donald Trump discussed his position on healthcare, and whether it is closer to Hillary Clinton’s or Bernie Sanders’: "I think I'm closer to common sense. We are going to repeal Obamacare. ... We are going to replace Obamacare with something so much better. And there are so many examples of it. And I will tell you, part of the reason we have some people laughing, because you have insurance people that take care of everybody up here. I am self-funded. The only one they're not taking care of is me. We have our lines around each state. The insurance companies are getting rich on Obamacare. The insurance companies are getting rich on health care and health services and everything having to do with health. We are going to end that. We're going to take out the artificial boundaries, the artificial lines. We're going to get a plan where people compete, free enterprise. They compete. So much better. In addition to that, you have the health care savings plans, which are excellent. What I do say is, there will be a certain number of people that will be on the street dying and as a Republican, I don't want that to happen. We're going to take care of people that are dying on the street because there will be a group of people that are not going to be able to even think in terms of private or anything else and we're going to take care of those people. And I think everybody on this stage would have to agree, you're not going to let people die, sitting in the middle of a street in any city in this country."[52]

* Trump suggested that he supported universal healthcare on September 27, 2015. “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now,” he said.[53]

* In a July 2015 Forbes interview on how Trump would replace Obamacare, a Trump spokesperson said, “Mr. Trump will be proposing a health plan that will return authority to the states and operate under free market principles. Mr. Trump’s plan will provide choice to the buyer, provide individual tax relief for health insurance and keep plans portable and affordable. The plan will break the health insurance company monopolies and allow individuals to buy across state lines.”[54]

###  Green Party[edit]

In a February 8, 2016, interview with Robert Scheer, Jill Stein (Green) said her approach to healthcare was similar to Bernie Sanders', explaining that the key difference between their positions was her plan to move the system to a single-payer system in "one fell swoop," rather than incrementally. Stein has also connected her energy and environmental policies to healthcare, stating that reducing pollution from fossil fuels would increase the health of Americans and reduce healthcare costs.[55][56]

The 2016 Green Party Platform on healthcare

| “  | F. Health Care

The Green Party supports single-payer universal health care and preventive care for all. We believe that health care is a right, not a privilege.

Our current health care system lets tens of thousands of people die each year by excluding them from adequate care, while its exorbitant costs are crippling our economy. The United States is the only industrialized nation in the world without a national health care system.

Under a universal, comprehensive, national single-payer health care system, the administrative waste of private insurance corporations would be redirected to patient care. If the United States were to shift to a system of universal coverage and a single payer plan, as in Canada and many European countries, the savings in administrative costs would be more than enough to offset the cost of additional care. Expenses for businesses currently providing coverage would be reduced, while state and local governments would pay less because they would receive reimbursement for services provided to the previously uninsured, and because public programs would cease to be the "dumping ground" for high-risk patients and those rejected by health maintenance organizations (HMOs) when they become disabled and unemployed. In addition, people would gain the peace of mind in knowing that they have health care they need. No longer would people have to worry about the prospect of financial ruin if they become seriously ill, are laid off their jobs, or are injured in an accident.

The Green Party supports a wide range of health care services, including conventional medicine, as well as the teaching, funding and practice of complementary, integrative and licensed alternative health care approaches.

Greens recognize that our own health is also intimately tied to the health of our communities and environment. To improve our own health, we must improve the quality of our air, water and food and the health of our workplaces, homes and schools.

The Green Party unequivocally supports a woman's right to reproductive choice, no matter her marital status or age, and that contraception and safe, legal abortion procedures be available on demand and be included in all health insurance coverage in the U.S., as well as free of charge in any state where a woman's income falls below the poverty level. [See section A.1. Women's Rights in this chapter]

We recommend the following actions:

1\. Single-Payer Health Care

Enact a universal, comprehensive, national single-payer health plan that will provide the following with no increase in cost:

a. A publicly funded health care insurance program, administered at the state and local levels, with comprehensive lifetime benefits, including dental, vision, mental health care, substance abuse treatment, medication coverage, and hospice and long-term care;

b. Participation of all licensed and/or certified health providers, subject to standards of practice in their field, with the freedom of patients to choose the type of health care provider from a wide range of health care choices, and with decision-making in the hands of patients and their health providers, not insurance companies;

c. Portability of coverage regardless of geographical location or employment;

d. Cost controls via streamlined administration, national fee schedules, bulk purchases of drugs and medical equipment, coordination of capital expenditures and publicly negotiated prices of medications;

e. Primary and preventive care as priorities, including wellness education about diet, nutrition and exercise; holistic health; and medical marijuana.

f. More comprehensive services for those who have special needs, including the mentally ill, the differently abled and those who are terminally ill;

g. A mental health care system that safeguards human dignity, respects individual autonomy, and protects informed consent;

h. Greatly reduced paperwork for both patients and providers;

i. Fair and full reimbursement to providers for their services;

j. Hospitals that can afford safe and adequate staffing levels of registered nurses;

k. Establishment of national, state, and local health policy boards consisting of health consumers and providers to oversee and evaluate the performance of the system, ensure access to care, and help determine research priorities; and

l. Establishment of a National Health Trust Fund that would channel all current Federal payments for health care programs directly into the Fund, in addition to employees' health premium payments.

2\. AIDS / HIV

The Green Party calls for comprehensive, humane, and competent care of all people with AIDS/HIV.

An all-out campaign must be waged against AIDS/ HIV and other blood-borne diseases such as hepatitis. The AIDS epidemic has not been adequately addressed at the local, state, federal, or international levels. All people in all countries, including those with AIDS/HIV, have a right to medical care, protection from discrimination, and confidentiality. Drug corporations have a strong profit motivation to make this disease a manageable one (like diabetes) with guaranteed sales of very expensive drugs, in the billions of dollars every year. Drug companies have not emphasized research that targets a cure. While new drugs have dramatically saved lives, many have side effects so debilitating that the quality of life is poor, if not intolerable during the extended lifetime of the patient. But even these need to be produced generically to stop the devastation resulting from corporate refusal to provide these drugs to the millions dying throughout the world who cannot afford these basic lifesaving drugs. Drug researchers should have a cure for AIDS as their ultimate goal.

We recommend the following actions:

a. Increased funding for AIDS education and patient care.

b. Increased funding for comprehensive sex education that includes AIDS education.

c. Increased funding for research focusing on a cure, methods of prevention, and on bolstering the immune system.

d. Improved technology, facilities, laboratories, researchers, staff and personnel to cure AIDS/HIV. A "Manhattan Project" for a cure is required.

e. Complete sharing of information among researchers, funding agencies (including corporations), and the public on AIDS/HIV before awarding the next research grant.

f. More research into better methods of prevention of HIV infection. While we support condom use, better condoms are also required. We support more vaccine research as well as research on prevention methods such as microbicides. People must be provided the means and support to protect themselves from all sexually transmitted diseases.

g. Equal access to AIDS education, treatment and medications for all affected. Accordingly, funding and accountability should be increased.

h. Allowing all prisoners affected with AIDS/HIV in all countries to have the same access as free citizens to education, treatment, preventive measures (including condom use), and medical care.

i. A uniform international definition of AIDS.

j. Protecting the confidentiality of all people diagnosed with AIDS/HIV or tested for HIV.

k. More careful and timely approval of effective AIDS drugs by the FDA.

l. Production of affordable and available versions of patented medicines in all countries.

m. Targeting the young for age-appropriate education about AIDS/HIV and appropriate methods of prevention. We support sex education and the distribution of condoms in schools.

n. Prevention awareness and access to condoms to prevent the spread of AIDS. We condemn HIV-related discrimination.

o. Make drug treatment and other programs available for all addicts who seek help.

p. Expand clinical trials for treatments and vaccines.

q. Speed-up the FDA drug approval process.

r. Providing housing for homeless and poor people with AIDS/HIV.

s. Providing treatment for homeless people with AIDS/ HIV.

t. Support for needle exchange programs and for programs to help drug addicts.

u. No mandatory screening for AIDS/HIV; anonymous screening must be available.

v. Lifting the ban prohibiting HIV positive people from entering the U.S. as visitors or as immigrants.[39]

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—2016 Green Party Platform[57]

#### Jill Stein on healthcare[edit]

See also: Jill Stein presidential campaign, 2016

* Stein spoke about several Colorado ballot measures at a campaign event in Denver on August 28, 2016, saying, “Colorado is leading the charge. These are the things we need to do at the national level.” Stein offered praise for a Medicare-expansion ballot measure. She said, “Ultimately, we want to go to a single-payer system” and the ballot measure “gets us started.”[58] In an interview with The Colorado Independent on August 27, 2016, however, Stein said she does not endorse the plan. “I don’t want to throw my weight behind an endorsement at this point. But I would certainly respect anyone who sees fit to work on it,” said Stein.[59]

* At a town hall event hosted by CNN on August 17, 2016, Stein was asked if she was “anti-vaccine.” Stein said, “I think there's kind of an effort to divert the conversation from our actual agenda. The idea that I oppose vaccines is completely ridiculous.”[60]

* In an interview with The Washington Post published on July 29, 2016, Jill Stein said that while vaccines were “an invaluable medication,” she was concerned with vaccine safety and government oversight of mandatory vaccinations. "Like any medication, they also should be — what shall we say? — approved by a regulatory board that people can trust. And I think right now, that is the problem. That people do not trust a Food and Drug Administration, or even the CDC for that matter, where corporate influence and the pharmaceutical industry has a lot of influence."[61]

* In a February 8, 2016, interview with Robert Scheer, Stein said her approach to healthcare is similar to Bernie Sanders'. She explained, "The one place we differ from Bernie on health care is by defending the Affordable Care Act, or saying that we're going to build on the Affordable Care Act, because that's the mythology that the health insurance system uses, that we can grow our way incrementally to a single-payer system. And you can't; you really have to kiss it goodbye and expand Medicare in one fell swoop, which can be done very quickly and efficiently."[62]

* During a February 5, 2016, interview, Jill Stein described how her "Green New Deal" would reduce healthcare costs. She said, "[W]hen you shut down the endless stream of pollution into our air, our water, our consumer products, etc., that derive from fossil fuels, we get so much healthier that it massively reduces our health care costs. And this is not just a hypothetical. This actually happened in the country of Cuba when their oil pipeline went down, so we know this is really true. When you take the pollution out of the air, you enable people to eat a fresh and healthy and sustainable food system and you integrate public transportation into walking and biking so we can actually use our own motor power to get places, that creates the real foundation for health that we in this country spend $3 trillion a year for. And we are only getting sicker; we are not getting better."[63]

* In a November 3, 2015, interview, Jill Stein said she would push for a Medicare-for-all system in her first 100 days if elected president. "The...thing that we will do is create health care as a human right, which is critical and also must be done in order for people to be productive and creative members of society we need to be healthy. And we’ll actually save money, not lose money, by moving to an improved Medicare-for-all, which is far simpler and saves about US$400 billion a year in waste, paper pushing, and pharmaceutical and insurance company profiteering. That money can be put toward covering everyone comprehensively."[64]

* On Stein's 2016 presidential campaign website, she stated she would like to "[e]stablish an improved 'Medicare For All' single-payer public health insurance program to provide everyone with quality health care, at huge savings."[65]

* In the 2012 "People's State of the Union," responding to President Obama's "State of the Union" address, Stein said, "[M]y administration will honor the right to quality health care through an improved Medicare for All program. This will provide comprehensive care for all. It will be free to consumers at the point of delivery, but will save money overall by reducing the massive wasteful health insurance bureaucracy and by stabilizing medical inflation. And it restores freedom of choice so you pick your health care provider, and your care is decided by you and your provider– not by a profiteering insurance executive. This will be federally financed and democratically controlled."[66]

###  Libertarian Party[edit]

Gary Johnson (Libertarian) voiced opposition to Obamacare, particularly the law's requirement to obtain health insurance, known as the individual mandate. In 2012, Johnson released a statement criticizing the United States Supreme Court decision that the penalty for failing to obtain insurance is a tax rather than a fine. The statement called the ruling "a truly disturbing decision" and advocated for competition and price transparency as methods for improving the affordability and availability of healthcare.[67]

The 2016 Libertarian Party Platform on healthcare

| “  | 2.10 Health Care

We favor a free-market health care system. We recognize the freedom of individuals to determine the level of health insurance they want (if any), the level of health care they want, the care providers they want, the medicines and treatments they will use and all other aspects of their medical care, including end-of-life decisions. People should be free to purchase health insurance across state lines.[39]

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—2016 Libertarian Party Platform[68]

#### Gary Johnson on healthcare[edit]

See also: Gary Johnson presidential campaign, 2016

* In a statement to Reason.com, Johnson sought to clarify his stance on mandatory vaccinations. He said, “Today, there are no federal laws mandating vaccinations, and that is as it should be. No adult should be required by the government to inject anything into his or her body. … Government has a responsibility to help keep our children and our communities safe. At the same time, government has a responsibility to preserve individual freedom. Vaccination policies must respect both of those responsibilities. I personally believe in vaccinations, and my children were vaccinated. But it is not for me to impose that belief on others.”[69]

* In 2011, Johnson tweeted that he was against mandatory vaccinations. But in an interview with Vermont Public Radio on August 24, 2016, Johnson said he had changed his position on the issue. "You know, since I’ve said that ... I’ve come to find out that without mandatory vaccines, the vaccines that would in fact be issued would not be effective. So, it’s dependent that you have mandatory vaccines so that every child is immune. Otherwise, not all children will be immune even though they receive a vaccine. In my opinion, this is a local issue. If it ends up to be a federal issue, I would come down on the side of science and I would probably require that vaccine," said Johnson.[70]

* In October 2012, Gary Johnson called the Affordable Care Act, also known as Obamacare, "a torpedo in a sinking ship." He said, "I think the economy’s going to collapse" as a result of the healthcare law.[71]

* In July 2012, Johnson said he was "opposed to government-mandated health insurance, period," in an interview with The Daily Caller.[72]

* After the Affordable Care Act was upheld as constitutional by the Supreme Court in June 2012, Johnson released a statement to criticize the decision. "Whether the Court chooses to call the individual mandate a tax or anything else, allowing it to stand is a truly disturbing decision. The idea that government can require an individual to buy something simply because that individual exists and breathes in America is an incredible blow to the bedrock principles of freedom and liberty. It must be repealed, and Congress needs to get about doing so today," Johnson wrote. He added, "Government cannot create a system that will reduce costs while increasing access. Only competition and the price transparency that competition will bring can accomplish the imperatives of affordability and availability."[73]

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# State issues[edit]

* ON THIS TAB:
* Medicaid expansion
* Health insurance exchanges
* Opioid crisis

### Common state issues[edit]

#### Medicaid expansion[edit]

As of March 2016, 31 states had expanded Medicaid to cover childless adults up to 138% of the federal poverty level, while 19 had not. Whether to expand the program, and how to do so, was still a heavily debated issue for states in 2016, even in some that had approved the expansion. In some states, like Kentucky, officials that had been newly elected in 2015 looked toward repealing or changing the terms of their expansion. In others, such as Alabama, new governors sought to persuade a skeptical legislature to approve an expansion.

#### Health insurance exchanges[edit]

Rising premiums coupled with insurer exits on state insurance exchanges presented challenges for state regulators. As state regulators approved 2017 premium increase requests from insurers, the nationwide average increase for benchmark exchange plans came to 25%. In some states, such as Tennessee and Minnesota, state regulators approved increases of around 50%. Tennessee Insurance Commissioner Julie Mix McPeak characterized the increases as necessary to prevent a "collapse" of the state's exchange. Meanwhile, five states were slated to have just one insurer offering plans statewide on their exchanges in 2017 as insurers withdrew due to heavy losses. Aetna's exit from the exchanges nearly left Pinal County, Arizona without any ACA insurance offerings in 2017, the first time such a situation has occurred in any state since the exchanges opened in 2014.[74][75]

#### Opioid crisis[edit]

Opioid addiction and overdose became an issue that the U.S. Department of Health and Human Services (HHS) characterized as a nationwide epidemic. Prescription opioids are typically used as treatment for chronic pain but can also be addictive. A well-known opioid is OxyContin; heroin is also an opioid. According to HHS, over 60% of overdose deaths in 2014 involved an opioid, and the rate of opioid overdose deaths had quadrupled since 1999. While all areas of the country were affected, the crisis was particularly concentrated in the Northeast and Appalachian regions. In response, at least three states enacted measures regulating how medical opioids such as OxyContin were prescribed.[76]

# Ballot measures[edit]

### Healthcare ballot measures[edit]

See also: Healthcare on the ballot

Ballotpedia tracked the following healthcare ballot measures in 2016.

Voting on Healthcare

Ballot Measures
By state
By year
Not on ballot
Local Measures

### Certified healthcare ballot measures[edit]

The following healthcare ballot measures were certified for the 2016 election.

1. Washington Taxation of Stand-Alone Dental Plans, Advisory Vote 14 (2016) | A "repealed" vote opposed House Bill 2768, advising against allowing Washington Healthplanfinder to levy an assessment to fund operations.[77]

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| A "maintained" vote supported House Bill 2768, which allows the state’s health insurance exchange, known as Washington Healthplanfinder, to levy an assessment on stand-alone family dental plans to fund operations.

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2. Nevada Medical Equipment Sales Tax Exemption, Question 4 (2016) | A "yes" vote supported this amendment to require the Nevada Legislature to exempt from sales and use tax durable medical equipment, oxygen delivery equipment, and mobility enhancing equipment prescribed for human use by a licensed health care provider.

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| A "no" vote opposed this amendment to require the legislature to exempt certain types of medical equipment from the sales and use tax.[78]

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### Proposed healthcare ballot measures[edit]

The following healthcare-related measures did not make the ballot in 2016:

1. Florida Medicaid Expansion Amendment (2016)
2. Missouri State Health Insurance Initiative (2016)
3. California Medical Marijuana Access Initiative (2016)
4. Nebraska Medical Marijuana Initiative (2016)
5. New York Alzheimer's Research Bond Act (2016)
6. Nevada "Healthcare Freedom Protection" Initiative (2016)
7. Washington Single Payer Healthcare Initiative (2016)
8. Oregon Universal Healthcare Initiative (2016)
9. Oregon Affordable Access to Healthcare Initiative (2016)
10. Oregon "Healthcare is a Human Right" Initiative (2016)
11. California "Fair Healthcare Pricing" Initiative (2016)
12. California Charitable Hospital Executive Compensation Initiative (2016)
13. California Charity Care Initiative (2016)
14. Massachusetts "Equitable Healthcare Pricing" Initiative (2016)
15. Oregon Maximum Allowable Charge for Healthcare Initiative (2016)
16. Michigan "Fair Medical Prices" Initiative (2016)
17. California Hospital Executive Compensation Limit Initiative (2016)

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## See also[edit]

* 2016 coverage on Ballotpedia

* Healthcare policy on Ballotpedia

* Presidential election, 2016

* United States Congress elections, 2016
* State executive official elections, 2016
* State legislative elections, 2016

## Footnotes[edit]

1. ↑ Forbes, "As Clinton-Trump Debate Looms, It's Drug Prices, Not Obamacare, Taking Stage," September 25, 2016
2. ↑ 2.0 2.1 The Henry J. Kaiser Family Foundation, "Prescription Drug Costs Remain Atop the Public’s National Health Care Agenda, Well Ahead of Affordable Care Act Revisions and Repeal," October 28, 2015
3. ↑ Modern Healthcare, "Virginia elections could signal future of Medicaid expansion," September 19, 2015
4. ↑ STAT, "GOP hopefuls, long quiet on drug prices, begin to make some noise," November 10, 2015
5. ↑ DonaldJTrump.com, "Healthcare reform to make America great again," accessed March 3, 2016
6. ↑ Hillary for America, "Hillary’s Plan to Respond to Unjustified Price Hikes for Long-Available Drugs," accessed October 10, 2016
7. ↑ Express Scripts, "Drug Trend Report," accessed February 23, 2015
8. ↑ The Pew Charitable Trusts, "High Drug Prices Prompt Demands for Transparency," March 7, 2016
9. ↑ STAT, "Vermont becomes first state to require drug makers to justify price hikes," June 6, 2016
10. ↑ Gallup, "More Americans Negative Than Positive About ACA," September 8, 2016
11. ↑ Henry J. Kaiser Family Foundation, "Kaiser Health Tracking Poll: January 2015," January 28, 2015
12. ↑ Henry J. Kaiser Family Foundation, "Kaiser Health Tracking Poll: August 2016," September 1, 2016
13. ↑ Congressional Research Service, "Legislative Actions to Repeal, Defund, or Delay the Affordable Care Act," December 9, 2015
14. ↑ Reuters, "House Republicans unveil healthcare alternative to Obamacare," June 22, 2016
15. ↑ The Pew Charitable Trusts, "Is Medicaid Expansion Near a Tipping Point?" January 26, 2016
16. ↑ The Henry J. Kaiser Family Foundation, "An Overview of Actions Taken by State Lawmakers Regarding the Medicaid Expansion," February 13, 2015
17. ↑ Advisory Board, "Where the states stand on Medicaid expansion," January 13, 2016
18. ↑ The New York Times, "Taking the Battle to the States," January 11, 2014
19. ↑ Kaiser Health News, "Long-Term Stability Of ACA In Doubt As Insurers Continue To Jump Ship," August 17, 2016
20. ↑ The Commonwealth Fund, "Why Are Many CO-OPs Failing?" accessed September 14, 2016
21. ↑ American Enterprise Institute, "Obamacare Co-ops: Cause Celebre or Costly Conundrum?" June 24, 2015
22. ↑ Healthinsurance.org, "CO-OP health plans: patients’ interests first," accessed August 25, 2016
23. ↑ Modern Healthcare, "One-third of ACA exchanges will lack competition in 2017," August 23, 2016
24. ↑ The Commonwealth Fund, "New Commonwealth Fund Report: Health Insurers' Financial Performance Varied in Aca's First Year; Payments to Reimburse Insurers for High-Cost Patients Were Successful," July 20, 2016
25. ↑ ACASignups.net, "Avg. Indy Mkt Rate Hikes: 24.6% Requested (all states); 25.5% Requested (19 states); 25.8% APPROVED (19 states)," August 14, 2016
26. ↑ American Academy of Actuaries, "Drivers of 2017 Health Insurance Premium Changes," accessed August 24, 2016
27. ↑ Assistant Secretary for Planning and Evaluation, "Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace," accessed October 27, 2016
28. ↑ The Commonwealth Fund, "How Stable Are the ACA Marketplaces?" December 3, 2015
29. ↑ Health System Tracker, "How much is health spending expected to grow?" accessed June 7, 2016
30. ↑ The Wall Street Journal, "New Evidence Health Spending Is Growing Faster Again," June 11, 2016
31. ↑ The Centers for Medicare and Medicaid Services, "National Health Expenditure Projections 2014-2024," accessed June 7, 2016
32. ↑ The Henry J. Kaiser Family Foundation, "Kaiser Health Tracking Poll: March 2016," March 23, 2016
33. ↑ CBS News, "The painful rise of high-deductible health insurance," February 8, 2016
34. ↑ Health Affairs Blog, "State Options To Control Health Care Costs And Improve Quality," April 28, 2016
35. ↑ Modern Healthcare: Vital Signs, "Blog: States taking lead in healthcare cost control," April 11, 2016
36. ↑ Modern Healthcare, "Drug companies play offense to justify high price tags," June 8, 2016
37. ↑ Hillary for America, "Affordable health care is a basic human right," accessed February 22, 2016
38. ↑ 38.0 38.1 38.2 Democratic Platform Committee, "2016 Democratic Party Platform," July 8-9, 2016
39. ↑ 39.0 39.1 39.2 39.3 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
40. ↑ CNN, "Republicans go on offense over Obamacare," October 25, 2016
41. ↑ HillaryClinton.com, "Hillary Clinton’s Comprehensive Agenda on Mental Health," accessed August 29, 2016
42. ↑ The Hill, "Clinton calls for EpiPen maker to lower price," August 24, 2016
43. ↑ The Atlantic, "Hillary Clinton to Congress: Come Back to D.C. and Fund Zika Research," August 9, 2016
44. ↑ CBS News, "Hillary Clinton to back public option for health care," July 9, 2016
45. ↑ The Washington Post, "Transcript of the New Hampshire GOP debate, annotated," February 6, 2016
46. ↑ The Washington Times, "Donald Trump: 'Obamacare will shut down this country,'" September 30, 2013
47. ↑ DonaldJTrump.com, "Healthcare reform to make America great again," accessed March 3, 2016
48. ↑ 48.0 48.1 48.2 Republican National Convention, "Republican Platform 2016," accessed August 5, 2016
49. ↑ CNBC, "Donald Trump blasts Obamacare — with a lot of help from running mate Mike Pence," November 1, 2016
50. ↑ CBS News, "Donald Trump: Birth control should not be done by prescription,'" September 15, 2016
51. ↑ DonaldJTrump.com, "Healthcare reform to make America great again," accessed March 3, 2016
52. ↑ The Washington Post, "Transcript of the New Hampshire GOP debate, annotated," February 6, 2016
53. ↑ Forbes, "On '60 Minutes', Donald Trump Says Obamacare Is A Disaster - But His Own Plan Is Even Worse," September 27, 2015
54. ↑ Forbes, "Donald Trump Hates Obamacare - So I Asked Him How He'd Replace It," July 31, 2015
55. ↑ Huffington Post, "Scheer Intelligence: Jill Stein-Presidential Candidate," February 8, 2016
56. ↑ Political People Blog, "Dr. Jill Stein on Foreign Policy, Bernie Sanders and a 'Green New Deal,'" February 5, 2016
57. ↑ Green Party, "The 2016 Green Party Platform on Social Justice," archived August 28, 2016
58. ↑ The Denver Post, "Green Party’s Jill Stein says Colorado leading the way to the future," August 28, 2016
59. ↑ The Colorado Independent, "In Colorado, Green Party’s Jill Stein won’t endorse the ColoradoCare universal healthcare ballot measure," August 27, 2016
60. ↑ CNN, "Jill Stein: I will have trouble sleeping at night if either Trump or Clinton is elected," August 17, 2016
61. ↑ The Washington Post, "Jill Stein on vaccines: People have ‘real questions’," July 29, 2016
62. ↑ Huffington Post, "Scheer Intelligence: Jill Stein-Presidential Candidate," February 8, 2016
63. ↑ Political People Blog, "Dr. Jill Stein on Foreign Policy, Bernie Sanders and a 'Green New Deal,'" February 5, 2016
64. ↑ teleSUR, "US Presidential Candidate Jill Stein: I Want to Be President to Save the World," November 3, 2015
65. ↑ Jill 2016, "Power to the People Plan," accessed July 7, 2015
66. ↑ ProCon.org, "Text: People's State of the Union," accessed July 7, 2015
67. ↑ Reason, "Gary Johnson on ObamaCare Ruling," June 28, 2012
68. ↑ Libertarian Party, "Platform," archived August 23, 2016
69. ↑ Reason, "Libertarian Gary Johnson Comes Out Against Carbon Taxes, Mandatory Vaccines," August 26, 2016
70. ↑ VPR, "In Reversal, Gov. Gary Johnson Now Supports Mandatory Vaccination," August 24, 2016
71. ↑ Politic365, "Libertarian Nominee Gary Johnson on Obamcare: 'A Torpedo in a Sinking Ship,'" October 17, 2012
72. ↑ Daily Caller, "Johnson reminds voters: Romney authored ‘the blueprint’ for Obamacare," July 23, 2012
73. ↑ Reason, "Gary Johnson on ObamaCare Ruling," June 28, 2012
74. ↑ Assistant Secretary for Planning and Evaluation, "Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace," accessed October 27, 2016
75. ↑ The Tennessean, "Tennessee insurance commissioner: Obamacare exchange 'very near collapse'," August 25, 2016
76. ↑ U.S. Department of Health and Human Services, "The Opioid Epidemic: By the Numbers," accessed October 12, 2016
77. ↑ Cite error: Invalid `<ref>` tag; no text was provided for refs named `housebill`
78. ↑ Cite error: Invalid `<ref>` tag; no text was provided for refs named `sbq`

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