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.

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.

Major issues[edit]

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]

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]

National races[edit]

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]

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]

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]

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]

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]

State issues[edit]

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. California Proposition 61, Drug Price Standards (2016)

   A "yes" vote supported regulating drug prices by requiring state agencies to pay no more than the U.S. Department of Veterans Affairs (VA) pays for prescription drugs.

   A "no" vote opposed this measure to require state agencies to pay no more than the VA pays for prescription drugs.

2. 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]

   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.

3. 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.

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

4. Colorado Proposition 106, Physician-Assisted Death Initiative (2016)

   A "yes" vote supported making assisted death legal among patients with a terminal illness who receive a prognosis of death within six months.

   A "no" vote opposed this proposal, keeping the prohibition of assisted death in Colorado.[79]

5. California Proposition 52, Continued Hospital Fee Revenue Dedicated to Medi-Cal Unless Voters Approve Changes (2016)

   A "yes" vote supported requiring voter approval to change the dedicated use of certain fees from hospitals used to draw matching federal money and fund Medi-Cal services. A "yes" vote also supported continuing the hospital fee program beyond January 1, 2018, and requiring a two-thirds majority vote of the California Legislature to end the program.

   A "no" vote opposed this initiative, allowing the fee to end on January 1, 2018, and permitting the legislature to change, extend, or eliminate the hospital fee program with a majority vote.

Proposed healthcare ballot measures[edit]

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

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]