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POTUS Candidate Update: Clinton proposes drug caps; Fiorina supports Individual Mandate; Sanders files to kill Cadillac tax

I've been debating (pun intended!) how to handle the ongoing 2016 Presidential primary season when it comes to the ACA. While the ACA has barely come up at all in either of the first 2 GOP debates, it's almost certainly going to start popping up sooner or later (and I'll be stunned if it isn't a major topic at the Democratic debates).

I'm gonna try doing an occasional "Candidate Roundup" with the latest ACA-related happenings when it comes to the various candidates...and there have been three major developments this week:

Hillary Clinton:

OK, I'm a little late to the party on this one, but gimme a break; yesterday was Yom Kippur. Timed very nicely to coincide with the recent ugly story about Turing Pharmaceuticals CEO Martin Shkreli, who snapped up the rights to a decades-old, life-saving drug which costs about $18 a pop and jacked the price up by an insane 5,000% (or "only" 4,000%, as he put in his original "defense" of the move), still-the-Democratic-frontrunner Hillary Clinton announced her own plan for expanding upon the Affordable Care Act with a package of further reform proposals.

I haven't had a chance to review most of them, but Andrew Sprung has done his own overview at Xpostfactoid:

Hillary Clinton's just-released package of proposed health reform proposals is very...Hillary Clinton. It's got a lot of moving parts and takes incremental whacks at a pervasive problem -- ever-rising out-of-pocket medical costs for the insured -- from multiple angles. On the one hand, it layers complexity on complexity. On the other hand, its patches are tailored to provide complementary plugs to different holes in coverage that deter people from obtaining needed care and drain thousands from their earnings. And by the way, the most powerful ideas are are well below the top line.

For a different view, Jed Graham (the only reporter working for Investor's Business Daily who's intellectually honest about his ACA criticisms) has this take on Clinton's prescription drug cap:

Hillary Clinton's vow to cap patients' out-of-pocket prescription costs at $250 a month may sound like a populist way to help consumers while sticking it to drug companies.

But the reality is it would raise premiums and modestly reduce the ranks of the insured, partly by pushing some small businesses to drop coverage. And, believe it or not, it's exactly what drug companies want.

As an example of how her plan would work, Clinton's presidential campaign points to Covered California. Starting in 2016, the state's ObamaCare insurance exchange will cap an individual's cost for any single covered drug at $250 a month under benchmark silver-level plans.

Carly Fiorina:

The Republican Party's flavor of the week, former Hewlett-Packard disaster CEO Carly Fiorina, has made a lot of headlines (and gained in Republican voter polls) recently due in large part to, quite simply, lying through her teeth about the contents of the controversial (and thoroughly debunked) anti-abortion Planned Parenthood video.

Today, however, she's probably wishing that no one would bring up her views on anything medical- or healthcare-related:

Carly Fiorina, who has joined other leading Republican presidential candidates in denouncing Obamacare, once backed an individual mandate to buy health insurance that could put her at odds with others in the GOP.

During a panel discussion on CNN's "Crossfire" in 2013 about the law with former CNN host Stephanie Cutter, Fiorina said she supports keeping the requirement that every American purchase health insurance.

As Ian Milhiser notes:

...Asking a Republican partisan to deny [the concept that the ACA is unconstitutional] it is like asking a Christian to deny that Jesus is the Son of God. Such is the primacy of the unconstitutionality of Obamacare in the Republican faith.

Yet, in a 2013 interview unearthed by CNN’s Chris Moody on Thursday, former tech executive and GOP presidential candidate Carly Fiorina breaks with her party on this most basic issue of political faith. Worse, when asked to comment on the 2013 video, a Fiorina campaign spokesperson repeats the heresy — Carly Fiorina supports an individual mandate, the original sin at the heart of Obamacare.

...The notion the individual mandate’s unconstitutionality is so central to the Republican faith, in other words, that the GOP literally rebuilt its entire theory of the proper role of the judiciary to accommodate the view that Obamacare is unconstitutional.

...the Heritage proposal was quite different from the Affordable Care Act, and it included a number of conservative fantasies such as voucherizing Medicare and slashing Medicaid. It is not, however, a meaningful constitutional distinction. As the four dissenting justices who sought to repeal the entire Affordable Care Act wrote in NFIB, “the Act before us here exceeds federal power” because it “mandat[es] the purchase of health insurance.” The fact that Fiorina would make her mandate smaller is irrelevant; any individual mandate is heresy under this reading of the Constitution.

UPDATE 9/25/15: Hmmm...looks like Fiorina has even more explaining to do to her fellow Republicans:

Perhaps even more awkward for Fiorina, however, is her involvement with a California-based nonprofit organization that promoted enrollment in Obamacare's health exchanges.

In her 2013 CNN appearance, Fiorina touted the Foundation for Health Coverage Education, which assists Americans with identifying health coverage options through simplified eligibility information. Upon joining the group's advisory board in June 2011, Fiorina said she was "proud of my association with FHCE and hope to highlight the service they provide through the power of technology and bringing information to one source."

Bernie Sanders:

As I noted the other day, the so-called "Cadillac tax" provision of the ACA is extremely controversial, with even many who otherwise support the law having serious problems with it. Hillary Clinton has been "looking at it" and has indicated that she's very much open to either killing it or at least making serious modifications.

Her chief opponent for the Democratic nomination, however, made his call official today...joined by several of his Democratic colleagues:

Sanders, Brown and Senate Democrats Introduce Bill to Stop Cadillac Tax

Thursday, September 24, 2015

WASHINGTON, Sept. 24 – Sen. Bernie Sanders (I-Vt.), Sen. Sherrod Brown (D-Ohio) and seven of their colleagues introduced legislation today to repeal a tax on certain health plans. Sanders opposed the provision when it was included in the Affordable Care Act, which was passed in 2010.

“What was true then is true now,” Sanders said. “Imposing an excise tax on health insurance plans would be a disaster for millions of middle class Americans. Some have said that this tax only falls on ‘Cadillac’ health care plans, but the reality is that the plans this bill will tax are more like Chevrolets. Workers have fought hard to negotiate decent healthcare benefits, often in exchange for lower pay. This excise tax unfairly punishes them.”

According to Sanders, “the tax not only punishes hard working Americans, it is simply bad policy. We should make sure that all Americans receive affordable, high quality health care.”

The Affordable Care Act imposes a 40 percent non-deductible excise tax on health plans with values exceeding $10,200 in coverage for individuals and $27,500 for families. The provision is indexed to inflation and will rise automatically over time, with the potential to eventually affect all employer-sponsored plans.

The bill would strike the excise tax while demanding that repeal be paid for. According to the Congressional Budget Office, this provision would generate $87 billion over 10 years. Senator Sanders has long advocated that revenue could be raised through a surtax on the wealthiest people in this country, a provision that was included in the House version of the ACA. At the time, that provision was estimated to raise $460 billion over ten years, more than five times the amount raised by the excise tax.

Sens. Patrick Leahy (D-Vt.), Mazie Hirono (D-Hawaii), Jeanne Shaheen (D-N.H.), Chris Murphy (D-Conn.), Richard Blumenthal (D-Conn.), Chuck Schumer (D-N.Y.) and Michael Bennet (D-Colo.) are cosponsors of the legislation.

Again, I don't know enough about the "Cadillac tax" to form much of an opinion on it, but this sounds like it's shaping up to be the Next Big Obamacare Fight®, along the lines of the Medical Device Tax which has caused some cross-party fissures as well.