Premium support. Some have proposed changing the structure of Medicare to a system of premium supports under which Medicare would make a payment on behalf of each beneficiary which would be used toward the purchase of health insurance coverage — either traditional Medicare or a private plan. This proposal was frequently debated in the 2012 election, supported by Speaker Paul Ryan and included in the House Republican Plan.
Prescription drug costs.Rising drug costs, especially high-priced specialty drugs, have emerged as a significant issue for consumers, Medicare and other payers, leading to a number of proposals to slow cost increases.
The future of the Affordable Care Act (ACA), including its Medicare provisions. A major issue in this election is whether the ACA should be repealed. The ACA included a number of changes to Medicare, such as reduced costs for Medicare-covered preventive services and prescription drugs, and several reforms to how Medicare pays for and delivers care to beneficiaries. If repealed, Medicare spending would increase by more than $800 billion over 10 years, according to the Congressional Budget Office.
Medicare buy-in for adults between the ages of 55 and 64. Allowing older adults to buy in to Medicare would provide another option for health insurance coverage, in addition to individual policies available to them in (or outside) the ACA Marketplaces.
Where the Candidates Stand
Hillary Clinton. Hillary Clinton supports maintaining the current structure of the Medicare program and opposes policies to transform Medicare into a system of premium supports. On the issue of prescription drug costs, Clinton supports allowing safe re-importation of drugs from other countries, allowing the federal government to negotiate drug prices in Medicare, especially for high-priced drugs with limited competition, and requiring drug manufacturers to provide rebates in the Medicare Part D low-income subsidy program equivalent to the rebates provided under Medicaid. Hillary Clinton does not support repealing the ACA or any of the Medicare provisions included in the law; rather, she supports expanding the law’s value-based delivery system reforms. On the issue of Medicare eligibility, Clinton has proposed to allow people ages 55 to 64 to buy into Medicare.
Donald Trump. Donald Trump has not stated his position on the issue of Medicare program restructuring or whether to allow older adults ages 55 to 64 to buy in to Medicare. Trump supports repealing the ACA, which would presumably mean repealing the law’s Medicare provisions. On the issue of prescription drug costs, Trump supports allowing safe re-importation of prescription drugs from other countries.