Tonight, we will witness the much anticipated Presidential debate being held at Hofstra University in Hempstead, New York, between two longstanding New York powerhouses: Secretary Hillary Clinton and Real Estate mogul, Donald Trump.  We should hope there is time for the candidates to clearly outline their healthcare policies and proposals.

Why Healthcare?

Healthcare will represent over 22% of total Federal, State, and Local Government spending in 2016. Expenditures are projected to be close to 20% of GDP as well. However, despite representing 1/5th of the economy and government spending, Presidential debates have not historically spent the same proportional time on the topic.

Healthcare has always been viewed as third rail in politics. The big two programs that make up most of the Healthcare spending are Social Security and Medicare. Even the staunchest laissez-faire capitalist have steered clear of proposing spending reforms on such popular programs despite their looming insolvency. The 272 paged 2016 Annual Report from the Social Security and Medicare Board of Trustees projects shortfalls in Social Security to begin in 2034; just 18 years away. Likewise, Medicare is projected to have depleted funds by 2028; at which time the funds will be sufficient to pay only 87% of Medicare Hospital Insurance costs.

New York, NY

Coincidentally, New York serves as a relevant backdrop for the 1st presidential debate of this year’s campaign; especially when it comes to Healthcare. New York serves as an interesting microcosm for all the threats and opportunities the nation is facing with runaway healthcare costs. Since the Affordable Care Act has passed, New York has had as much good news as bad news.

  • The Good News: Since the law passed, the number of New Yorkers without insurance decreased by 850,000. The uninsured rate has been cut in half from 10% to 5%; the lowest rate in decades. Many of those that gained coverage enrolled in Medicaid, which has helped hospitals lower the rate of healthcare services delivered to people who lack the means to pay for it (uncompensated care).
  • The Bad News: Health Republic, the largest Health Exchange/Affordable Care Act healthcare plan in 2014 went out of business in less than two years. Many other large health insurance companies had also pulled out of the market stating unsustainable market conditions. NY hospitals continue to struggle financially stimulating downsizing, closures and mergers. Since 2000, 19 hospitals have closed in just New York City.

On To The Debate

Lester Holt has a very important task as tonight’s debate moderator. It is imperative that the candidates highlight their policy positions. That requires the right environment for a true policy discussion to take place.

The debate will be ninety minutes long split up into six different fifteen minute segments.  Healthcare should be one of those segments. The moderator will open each section with a question and candidates will give alternating two-minute responses followed up with 10 minutes of open discussion. There will be no commercial breaks and crowd feedback will be limited.

DONALD TRUMP ON HEALTHCARE

Click Here for Donald Trump positions on Healthcare

Questions to ask him tonight:

Question 1: What will be the top three impact to the millions of americans currently receiving health insurance coverage through the Affordable Care Act after it is repealed and replaced by your administration? Please be specific.

Question 2: Based on your policy to end the “individual mandate”, how will you incentivize young healthy people to enroll into healthcare plans so that the insurance pools stay balanced and stable?

Question 3: Many worry that the removal of the barriers that inhibit the sale of health insurance across state lines would create a race to the bottom; meaning the states with the most relaxed rules and provisions would end up insuring a disproportionate share of the country. Is there anything in your policy position that will prevent that from happening?

HILLARY CLINTON ON HEALTHCARE

Click Here for Hillary Clinton positions on Healthcare

Questions to ask her tonight:

Question 1: In your pursuit to “defend and further extend” the Affordable Care Act, please offer up to three specific ways you will bring down the high out-of-pocket costs of deductibles and copayments while simultaneously keeping health plans affordable? Usually lower deductibles mean higher monthly premiums.

Question 2: In our free market economy, please give up to three specific ways on how you plan to reduce prescription drug spending by protecting consumers from unjustified price increases on life saving drugs?

Question 3: The Affordable Care Act as written does not offer insurance coverage to undocumented Americans; however your platform seeks to expand access to healthcare regardless of someone’s immigration status. Please discuss how this would work and specifically how this program would be paid?