2016 presidential viewpoint: 44 views on healthcare from Bush, Carson, Rubio, Paul, Clinton

 About one dozen Republican candidates and four Democratic candidates have declared their candidacy for the presidential nomination to date. Here are a handful of the presidential hopefuls' views on healthcare, in order of their announcements to run. We will continue to update this list.

John Ellis "Jeb" Bush, former governor of Florida — Republican candidate

1. Mr. Bush feels the Patient Protection and Affordable Care Act is "flawed to its core," according to The New York Times. While serving on the board for Dallas-based Tenet Healthcare from 2007 to 2014, Mr. Bush made his personal views on the PPACA clear, but kept his personal views separate from his professional duties, Tenet CEO Trevor Fetter told The New York Times. Tenet supported the law and encouraged people to sign up for insurance under it.

2. Mr. Bush would like to repeal the PPACA and replace it with consumer-directed and "catastrophic" health plans. He believes in providing catastrophic coverage that covers just major medical issues rather than comprehensive coverage, according to Politico, and he would like to install a consumer-directed model to give patients more choice.

3. Medical billing is nontransparent, he says. After a 2013 knee surgery, Mr. Bush commented on the billing process while speaking in Wisconsin. "The whole experience is opaque," he said, according to the Milwaukee Journal Sentinel. "It's like smoke comes up, you don't know what's really happening, the third party pays."

4. Mr. Bush has spoken out against Medicaid expansion. In 2013, Mr. Bush spoke out against current Florida Gov. Rick Scott's move to accept federal funds to expand Medicaid because the federal funding would phase down, according to CNN. Gov. Scott has flip-flopped on Medicaid expansion since; this year he threatened to sue the federal government for withholding money to force Florida to expand the program.

5. As governor of Florida, Mr. Bush implemented a Medicaid managed care pilot program. His 2005 "empowered care" pilot program would make Florida the first to allow Medicaid beneficiaries to buy their own health insurance from managed care organizations with vouchers, according to The New York Times. The idea was to let consumers shape the market to lower costs. The program did control costs: According to Politico, a study found counties that implemented the pilot slowed Medicaid spending growth to just $1 per person per month, compared with up to $28 per person per month in other counties. However, plans in this pilot ranked lower than the national average on 21 of 32 quality indicators, according to Bloomberg.

6. Mr. Bush has supported lowering medical insurance costs. In 2003, Mr. Bush signed a bill in Florida to reduce medical malpractice insurance to keep physicians from closing their practices. The law capped noneconomic damages to $500,000 in most cases, but did not limit economic damages, according to the Los Angeles Times.

7. Medicare beneficiaries should be required to sign an advance directive, Mr. Bush says. While serving as governor of Florida, Mr. Bush intervened in the Terri Schiavo case and passed a law supporting Ms. Schiavo's parents, the Schindlers, who wanted to keep her alive despite her permanently vegetative state. Ms. Schiavo's husband wanted to remove her feeding tube. The law was ultimately ruled unconstitutional and Ms. Schiavo died in April 2005, according to The Washington Post. "I think if we're going to mandate anything from government, it might be that if you're going to take Medicare that you also sign up for an advanced directive where you talk about this before you're so disabled that then there's fights amongst the family," Mr. Bush said this April. "I know for a fact that the Schindlers were more than happy to take over the care of this child. And I supported that."

8. He sees wearables as the future of healthcare. "On [the Apple Watch] in five years will be applications that will allow me to manage my healthcare in ways that five years ago were not even possible," Mr. Bush said in May while speaking at a brewery in Tempe, Ariz. "We'll be able to guide our own healthcare decisions in a way that will make us healthy. Ultimately, we have to get to a health system, away from a disease system."

9. Mr. Bush is pro-vaccines. This February he stated simply, "Parents ought to make sure their children are vaccinated," according to NBC News.

10. Mr. Bush does not support abortion. According to Real Clear Politics, Mr. Bush was a staunch opponent of abortion rights during his tenure as governor of Florida. For example, he supported a "choose life" specialty license plate that benefitted adoption organizations. Additionally, in 2003, he illustrated his belief that life begins at conception when he asked a circuit court to appoint a guardian for the fetus of a mentally disabled rape victim.

 

Ben Carson, MD, retired neurosurgeon — Republican candidate

1. Dr. Carson called the PPACA "the worst thing that has happened in this nation since slavery."

2.Dr. Carson believes there is a need to re-establish a strong and direct relationship between patients and their physicians.

3. Dr. Carson strongly supports health savings accounts and says they "empower families to make their own decisions about their medical treatment."

4. Overall, Dr. Carson supports more freedom and less government involvement in healthcare.

 

Marco Rubio, senator of Florida — Republican candidate

1. Sen. Rubio wants to repeal the PPACA. According to Sen. Rubio's government-official website, he believes the PPACA will "drive up costs, bankrupt the country and create bureaucratic red tape when it comes to everyday healthcare decisions." Sen. Rubio has three main goals regarding the PPACA, including repealing and replacing it, allowing individuals to control their own healthcare choices and returning control of health policy to the states.

Despite his stance against the PPACA, Sen. Rubio enrolled his family in one of its health plans in 2013 and accepted the $10,000 federal subsidy other Republicans rejected, according to the Miami Herald.

2. America needs to take "simple, common sense actions" to lower healthcare costs, according to Sen. Rubio. Such actions include "allowing individuals to purchase health insurance across state lines, encouraging small businesses to band together to form Association Health Plans, giving individuals the same tax breaks given to businesses, incentivizing the use of electronic medical records, giving people tools to make cost-conscious decisions, increasing the number of community health centers, incentivizing state medical malpractice reform, enhancing Health Savings Accounts, pursuing medical malpractice reform and adopting a sensible program to cover those with pre-existing conditions," according to his website.

3. Sen. Rubio has a three-part plan for a post-PPACA era. If the Supreme Court rules in favor of the plaintiff in the King v. Burwell trial challenging the legality of federal subsidies supplied to eligible individuals on HealthCare.gov, Sen. Rubio has a three-part plan to mitigate the collapse of the law.

In an article he authored for Fox News, Sen. Rubio wrote the first step would be to provide every American with an advanceable, refundable tax credit to buy healthcare coverage, with the value of these credits increasing annually. The second step includes reforming insurance regulations to encourage innovation so Americans with pre-existing conditions, as well as those living in high-cost states, have the opportunity to purchase coverage through their state's federally supported high-risk pools and across state lines. Third, Sen. Rubio believes Medicaid should be moved into a per-capita system to preserve funding for its populations while "freeing states from Washington mandates," and Medicare should be transitioned into a premium support system to empower seniors with choice and market competition similar to Medicare Advantage and Part D.

4. Sen. Rubio believes taxpayers should never be asked to bail out an insurance company. In April 2014, Sen. Rubio introduced the ObamaCare Taxpayer Bailout Protection Act. The act includes "legislation to hold the administration accountable by ensuring ObamaCare's risk-corridor provision remains budget neutral, which would prevent taxpayer dollars from being used to bailout insurance companies." This act was a follow-up to Sen. Rubio's attempt to protect taxpayers from a PPACA bailout after introducing the ObamaCare Taxpayer Bailout Prevention Act in November 2013.

5. There is an urgent need to save Medicare, Sen. Rubio says. In a May 2014 speech delivered at the National Press Club in Washington, D.C., Sen. Rubio outlined what he believes are two important truths regarding Medicare: The Medicare program is essential to maintaining a secure, healthy and comfortable retirement for seniors, and if it is not reformed, Medicare will go bankrupt in about 12 years and cease to exist. He proposed transitioning to a premium support system that provides seniors a "generous but fixed" amount of money to buy health insurance from Medicare or a private provider.

6. Sen. Rubio believes abortions should be illegal after 20 weeks of pregnancy. A co-sponsor of the "Pain-Capable Unborn Child Protection Act," introduced in the Senate in late 2014, Sen. Rubio supports the prohibition of abortions after 20 weeks on basis that fetuses can feel pain at the point of development, according to MSNBC.

7. Sen. Rubio says the Department of Veterans Affairs needs to be held accountable for its various lapses. Last year, he proposed legislation to increase accountability within the VA by giving the VA secretary the authority to fire workers, particularly executive leaders, who "aren't doing their jobs." Congress passed the legislation, though only three executives have been fired and only one in relation to the VA scandal. Sen. Rubio supports reforming the VA system by turning it into an independent, government-chartered non-profit corporation, effectively freeing it from bureaucratic and political constraints.

8. "All children…should be vaccinated." Sen. Rubio is a strong supporter of child vaccinations. "Absolutely, all children in America should be vaccinated," Sen. Rubio told NBC News. "Unless their immune [system is] suppressed, obviously, for medical exceptions, but I believe that all children, as is the law in most states in this country, before they can even attend school, have to be vaccinated for a certain panel."

9. In October 2014, Sen. Rubio introduced an Ebola travel ban legislation. The legislation would have imposed "common sense travel restrictions by creating a temporary ban on new visas for nationals of the countries of Liberia, Guinea and Sierra Leone," according to a news release. The ban would be effective until the Centers for Disease Control and Prevention certified the Ebola outbreak is contained.

10. He supports the use of medical marijuana, but only the noneuphoric type the Florida Legislature approved. In January, Sen. Rubio told the Tampa Bay Times, "You hear compelling stories of people who say the use of medicinal marijuana provides relief for the thing they are suffering. So I'd like to learn more about that aspect of it, the science of it. I have qualms about that proposal, I really do, but I probably need to learn more about it. The broader issue of whether we should be legalizing it is something I'm pretty firm about. I don’t think legalizing marijuana or even decriminalizing it is the right decision for our country."

 

Hillary Clinton, former first lady, former senator of New York and former secretary of state — Democratic candidate

1. Ms. Clinton supports the PPACA. On March 23, the fifth anniversary of President Obama's signing of the law, Ms. Clinton tweeted, "#ACA@5: 16m covered. Young ppl. Preexisting conditions. Women get better coverage. Repeal those things? Embrace them!" Last June she told PBS NewsHour, "If I were a Democrat running for reelection in 2014, I would be posing a very stark choice to the voters of my district, or my state. If you want us to go back to the time when your sister with diabetes, or your husband with his heart condition, couldn't get insurance at an affordable rate, then don't vote for me, because I think it's great that your sister and your husband now have insurance."

2. Ms. Clinton has also said she is open to fixing the PPACA. In the same interview with PBS NewsHour last June, Ms. Clinton said, "I think people should say, look, 'We're going to learn more about how [the PPACA is] working, and if there are adjustments that need to be made as we go forward, wouldn't you rather have somebody who wants to keep the good, and fix what's not working, than somebody who wants to undermine it, and maybe throw it out. These are very stark choices."

3. Ms. Clinton has long been a proponent of universal healthcare. As the leader of former President Bill Clinton's Task Force on National Health Reform, Ms. Clinton helped develop the Health Security Act, which aimed to make sure all Americans had health insurance. The bill included universal coverage for U.S. citizens and permanent residents, with stipulations to limit minimum coverage and maximum out-of-pocket fees. It also included provisions to set up regional alliances that structured competition among health insurance companies and provisions for Medicaid patients. The bill was later defeated in Congress, but became an early career-defining move. Many saw this attempt at healthcare reform as a major failure for Ms. Clinton.

4. As a Democratic hopeful in the 2008 presidential race, Ms. Clinton also ran on a new and improved universal health plan, called the American Health Choices Plan. This plan offered more choices for the insured and uninsured, limited premiums based on income, tax credits for small businesses and provisions to improve Medicaid and CHIP. It included an "individual mandate," requiring each individual to get coverage — a contended part of the plan, as some believed lower income Americans would be burdened by paying for a health plan, according to The Washington Post. The plan would have cost roughly $110 billion annually, and would have been financed by ending most of the Bush-era tax cuts.

5. Ms. Clinton is a long-time supporter of children's health initiatives. She was instrumental in expanding the State Children's Health Insurance Program, now called CHIP. Sen. Edward M. Kennedy told the Associated Press in 2007, "The children's health program wouldn't be in existence today if we didn't have Hillary pushing for it from the other end of Pennsylvania Avenue," according to FactCheck.org. The 18-year-old plan has provided millions of American children with health insurance coverage since its inception.

6. She also has been a proponent of women's reproductive rights. After the Hobby Lobby ruling in 2014, Ms. Clinton said, "Among those rights is control over their bodies, control over their own health care, control over the size of their families … where women and women's bodies are used as the defining and unifying issue to bring together people — men — to get them to behave in ways that are disadvantageous to women but which prop up them because of their religion, their sect, their tribe, whatever. So to introduce this element into our society… it's very troubling," according to Bustle. She is pro-choice, believes the morning-after pill should be accessible and defends women's rights to have access to full healthcare.

7. While serving in the Senate, she advocated for healthcare for workers at Ground Zero and military reservists. Ms. Clinton became a Senator in 2000, and during her tenure she supported programs that invested in tracking the healthcare of workers who helped clean up the 9/11 site. She also co-sponsored a law to expand healthcare access for military reservists and the National Guard called TRICARE.

8. She has supported the requirement of EHRs for federal healthcare programs, including Medicare, Medicaid and the Department of Veterans Affairs. At the 2007 SEIU Democratic Health Care Forum in Las Vegas Ms. Clinton supported an interoperable EHR system across federal healthcare. She said, "After Hurricane Katrina I went down to Houston to see the people who had been evacuated, most in them from the convention center. The elderly, the frail. People who were very dependent upon health care, their records were gone. Those 15 pieces of paper were destroyed. And a lot of doctors told me their biggest problem was trying to figure out what prescriptions to give to people. The only people they could help were the people who had shopped at chain drug stores because they had electronic medical records. If we had that for all of our health records, we'd get costs down and we'd have higher quality health care."

9. Her opinion on medical marijuana has changed since her 2007 campaign. Last year, Ms. Clinton said "she doesn't think 'we've done enough research yet' on medical marijuana questions, but said 'there should be availability [of marijuana] under appropriate circumstances,'" according to CNN. This diverges from her 2007 campaign, in which she stated she was against decriminalization of the drug.

10. She is pro-vaccines.  Ms. Clinton tweeted on Feb. 3 to her followers, "The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let's protect all our kids. #GrandmothersKnowBest," referring to herself as a grandmother of Charlotte, Chelsea Clinton's young daughter. 

This may also signal a divergence from her earlier views. According to TIME, Ms. Clinton filled out a survey in 2008 from the Autism Action Network and said, "I am committed to make investments to find the causes of autism, including possible environmental causes like vaccines."

 

Rand Paul, MD, senator of Kentucky — Republican candidate

1. Dr. Paul, 52, practiced ophthalmology for 18 years before becoming a senator in 2010. Dr. Paul moved to Bowling Green, Ky., in 1993. There he worked for Downing McPeak Vision Centers and the Gilbert Graves Clinic for about 15 years combined before launching his own ophthalmology practice in town.

2. Dr. Paul earned his medical degree from Duke University School of Medicine in Durham, N.C., in 1988. After that, he completed his general surgery internship at Atlanta-based Georgia Baptist Medical Center, followed by a residency in ophthalmology at Duke University Medical Center, completing his training in 1993. Despite his extensive medical training, Dr. Paul does not hold a bachelor's degree, according to NPR. He attended Waco, Texas-based Baylor University to study biology and English, but left a few courses short of a diploma after he was accepted into medical school.

3. His ophthalmology certification is contested. He originally earned board certification in 1993 after the completion of his residency. However, in 1997 he formed his own board, called the National Ophthalmology Board, with 200 other physicians in protest of certification requirement changes by the American Board of Ophthalmologists. The now-defunct board was not recognized by the Kentucky Board of Medical Licensure, so Dr. Paul was not board certified by a board recognized by the state since 2005. Since Dr. Paul's board dissolved in 2011, he has had no certification from an active body, according to the Washington Post. Kentucky state law does not require board certification for licensure.

4. Dr. Paul was involved in expanding access to eye care in his community and abroad. He founded the Southern Kentucky Lions Eye Clinic in 1995 to provide patients and families in need with eye exams and surgeries. In 2002, he was awarded with the Twilight Wish Foundation Outstanding Service and Commitment to Seniors award, and he has performed many pro-bono eye surgeries for patients in Kentucky and in other countries through the Children of the Americas Program.

5. Dr. Paul does not support the PPACA. His campaign website reads, "I was not a member of the U.S. Senate during the 111th Congress, but if I had been I would have voted against Obamacare. As your president, one of my first acts would be to repeal the abomination that is Obamacare."

6. Dr. Paul is in favor of a free-market approach to healthcare. He says he believes increased government interventions drive up the cost of coverage and decrease competition. As a senator, he publically supported making medical expenses tax deductible, allowing businesses to provide coverage and allowing physicians to negotiate costs with insurance companies and Health Savings Accounts.

7. He believes in higher Medicare deductibles and moving to a premium support system. In a 2010 interview, Dr. Paul said "You want to have more participation by the person who's receiving the entitlement. By that I mean that they need to be more involved with some sort of economic transaction every time they use their entitlement, and that means they have to bear more of the burden," according to Bloomberg Business. Dr. Paul supports a premium support system for Medicare, which would give seniors the ability to choose between traditional Medicare and private insurance on an exchange, according to Vox.

8. Dr. Paul supports vaccines, but believes they should be voluntary. "I've heard of many tragic cases of walking, talking, normal children who wound up with profound mental disorders after vaccines," Dr. Paul said, according to CNN. "I'm not arguing vaccines are a bad idea. I think they're a good thing. But I think the parents should have some input." He later followed up and said he is vaccinated, his children are vaccinated, he supports vaccines and he does not believe they cause disorders, but that they are "temporally related."

9. His comments on Ebola have also garnered media attention. In an interview with CNN last October, Dr. Paul shared the following comments: "[The Obama administration] has downplayed how transmissible [Ebola] is. They say it's the exchange of bodily of fluids. Which makes people think, 'Oh, it's like AIDS. It's very difficult to catch.'

"If someone has Ebola at a cocktail party, they're contagious and you can catch it from them," Dr. Paul continued. "[The administration] should be honest about that."

10. Dr. Paul believes medical marijuana is a state's rights issue, not a federal one. He recently teamed up with two Democrats to introduce a bill that would protect medical marijuana buyers and sellers from federal prosecution in states where marijuana is legal for medical and recreational purposes. He has also supported lessening the sentence for nonviolent marijuana offenders.

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