his is the second article in SIECUS’ continuing series uncovering the presidential candidates’ views on topics related  to sexual and reproductive health and rights.

Health care reform is one of the major issues of the 2008 presidential elections; an August 2007 Kaiser Health Tracking Poll found that health care is the top domestic issue Americans want candidates to address during their campaigns.¹  Each of the three main Democratic candidates has unveiled a plan to provide universal health coverage, and many of the Republican candidates have detailed their positions on the issue as well.

While sexual and reproductive health issues such as HIV, STDs, and access to contraception, abortion, and full reproductive health services are vital to any plan to reform health care, it is not surprising that the candidates’ plans include few details on these often controversial issues. 

“All of the Democratic candidates have now come out with big plans,” said Drew Altman, president of the Kaiser Family Foundation. “Those plans in the end are going to look more similar than different to Democratic voters in the primaries.” ²  Senators Hillary Clinton (D-NY), Barack Obama (D-IL.) and John Edwards (D-NC) have similar visions for the future of health care in America.  All three candidates aim to make health care more affordable through tax deductions, eliminate discrimination based on pre-existing conditions, provide more coverage choices, expand Medicaid and the State Children’s Health Insurance Program (SCHIP),  and require employers to contribute to their employees’ health insurance.  Each candidate is insistent that Americans who are happy with their existing insurance will be able to both retain their existing coverage and also pay less for it.  The Democratic candidates have yet to comment on how reproductive health services will be covered under their plans.

One of the most contentious aspects of the Democratic health care plans is whether insurance will be mandatory for all Americans.  Both Edwards and Clinton would require U.S. residents to participate in some form of health coverage, but Obama would require health insurance only for children.  Obama has also incorporated what he calls a National Health Insurance Exchange into his plan.  The Exchange would act as a “watch dog” by creating rules and standards for the private insurance market to ensure fairness, affordability, and accessibility.³

John Edwards’ universal health care plan would create regional “health care markets” that would provide a choice of competing insurance plans, with at least one public plan based on Medicare.  These plans would include comprehensive benefits and options for additional services.  The markets would be available to anyone without comparable insurance from another source.⁴  Edwards has also set himself apart from the other democratic candidates as the first candidate to specifically address the issue of HIV/AIDS within his health care plan.  (A future SIECUS Policy Update in this series on candidates’ views will cover the issue of HIV/AIDS.)

Hillary Clinton was the last of the major Democratic candidates to unveil her plan for universal health care.  Clinton says she has learned from the mistakes she made during her 1994 failed health care initiative: “This is not government run. There will be no more bureaucracy. This plan expands personal choice and increases competition to keep costs down.” “These are new times and this is a new plan,” she said.⁵  Yet despite the publicity surrounding it, Clinton’s health care plan is very similar to the plans created by both Barack Obama and John Edwards.  Clinton’s “American Health Choices Plan” will offer tax cuts to alleviate health costs and require employers to provide health care or contribute to the cost of insurance.  Small businesses will also receive tax credits to help them continue or begin to cover their employees.  The plan will continue to exclude taxes from employer-provided health care premiums, but will limit the exclusion of the “high-end portion” of plans for those making more than $250,000 per year.⁶

Like the democratic candidates, there are many similarities among the Republican candidates’ positions on health care.  Former New York City Mayor Rudy Giuliani, Senator Sam Brownback of Kansas,  former Senator Fred Thompson of Tennessee, and former Governor Mitt Romney of Massachusetts all advocate for free-market, consumer-controlled solutions to the health care issue, rather than an over-hauling of the entire system.  While none of the Republican candidates has produced a comprehensive health care plan, they are all wary of what they view as the “socialized medicine” plans of the Democratic Party and have even renewed the tired mantra of “Hillarycare.”  The Republicans candidates have not yet included reproductive health issues in their health care discussions, but their views on abortion and contraception will be covered in a future policy update.

During the CNN Republican presidential debate on June 5, 2007, Giuliani said that “health insurance should become like homeowner’s insurance or like car insurance. You don’t cover everything on your homeowner’s policy. If you have a slight accident in your house, if you need to refill your oil with your car, you don’t cover that with insurance. But that is covered in many of the insurance policies, because they’re government-dominated and they’re employer-dominated.”⁷  Giuliani believes that these policies are inefficient because of the time and paperwork required to cover the “slight accidents and oil refills” of health care.  Giuliani proposes a tax deduction of up to $15,000 per family for the purpose of health coverage and the creation of health savings accounts to enable people to save money for basic medical expenses. The savings accounts would then be used to alleviate the dependency on insurance by allowing people to pay for basic medical care. 

As Governor of Massachusetts, Mitt Romney was instrumental in enacting a type of universal health care plan requiring all citizens to purchase health insurance if it is determined that they can afford it, and providing subsidies for those who cannot.  As a Republican presidential candidate he advocates for the deregulation of private health insurance companies and the redirection of federal funds away from subsidizing health care for the poor and toward helping the poor purchase their own health insurance.⁸

SIECUS will continue to monitor and report on the Presidential candidates’ positions on sexual health during the electoral cycle.  We also encourage readers to register to vote, learn more at http://www.eac.gov/voter/Register%20to%20Vote.

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