Health Care Perspectives from the Presidential Candidates

Undeniably, this year’s presidential campaign has been significantly more entertaining than usual. With a little more than a month remaining before the Republican and Democratic National Conventions, the leading candidates have made a few important details available about their respective health care policy priorities. Donald Trump and Hillary Clinton’s health care platforms reflect their dramatically different approaches to how the federal government should manage the provision of health care. Below is a closer look at the candidates’ health care platforms.

Donald Trump

Trump has a series of proposals, each of which would require Congress to change current law, which could be possible if the Republicans maintain control of the House and Senate. Following is a summary of Trump’s plan:

• Repeal the Patient Access and Affordable Care Act (ACA)
   
• Allow the sale of health insurance across state lines
   
• Allow individuals to fully deduct health insurance premium payments from their tax returns
   
• Work with states to ensure that those who want health care coverage have access
   
• Allow individuals to use Health Savings Accounts (HSAs); contributions into HSAs should be tax-free and should be allowed to accumulate
   
• Require price transparency from all health care providers, especially doctors, clinics and hospitals
   
• Block grant Medicaid to the states
   
• Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products
   

A March 2016 analysis reports that Trump’s health care plan would result in about 21 million people in total losing health insurance and cost about $270 billion over 10 years. The analysis is from the Committee for a Responsible Federal Budget (CRFB), and studies the health care plan Trump released in early March, which includes many popular Republican concepts. Trump’s plan calls for fully repealing the ACA, which the Congressional Budget Office (CBO) projects would lead to 22 million people losing health insurance. Trump’s plan calls for the common Republican ideas of creating a tax deduction for individuals’ insurance premiums and allowing insurance to be sold across state lines. The CRFB found that these policies would add coverage for 1.1 million people.

In addition to coverage implications, there is also a cost to Trump’s plan, much of it coming simply from repealing the ACA. Repealing the ACA costs money, according to the CBO, because the loss of new taxes and Medicare cuts more than outweighs the savings from undoing spending on the coverage expansion. The CRFB found that repealing the ACA would cost $200 billion over 10 years.

Trump’s replacement then adds $70 billion in additional costs. Those costs come from the $100 billion to create the tax deduction for insurance premiums, $30 billion of which is offset by allowing insurance to be sold across state lines and allowing the importation of cheaper prescription drugs from abroad. The end result, including the costs of repealing the ACA and Trump’s replacement, is $270 billion over 10 years. Trump’s plan also does not include provisions to allow people with preexisting health conditions to obtain coverage, something that Trump says he supports, but would be eliminated with the repeal of the ACA. In addition, Trump’s plan calls for converting Medicaid into block grants to the states; however, he does not provide details on how big these block grants would be, so it is impossible to estimate the effects.

Hillary Clinton

Clinton’s health care platform is more straightforward in that she promises to maintain and build upon the Affordable Care Act (ACA). In addition, Clinton proposes to limit rising prescription drug prices by allowing the federal government to negotiate drug prices through Medicare and letting Americans import drugs from abroad. Clinton would also protect women’s access to reproductive health care, and expand coverage to all Americans by making premiums more affordable. Her plan would also lessen out-of-pocket expenses for consumers purchasing health insurance on the state and federal insurance exchanges.

Clinton also proposes to provide a tax credit of up to $5,000 per family to offset a portion of out-of-pocket and premium costs above 5 percent of their income. (Currently, taxpayers can only deduct medical costs in excess of 10 percent of their adjusted gross income; the threshold is 7.5 percent for senior citizens.) Clinton would enhance the premium tax credits now available through the exchanges so that those now eligible would pay less of a percentage of their income than under current law and ensure that all families purchasing on the exchange will not spend more than 8.5 percent of their income for premiums.

Clinton would also require drug companies that receive taxpayer support to invest in research and would eliminate corporate tax write-offs for direct-to-consumer advertising, instead requiring the proceeds be invested in research. Clinton would require health insurance plans to cap out-of-pocket prescription bills to $250 a month for patients with chronic or serious health conditions.

Clinton would support new incentives to encourage all states to expand Medicaid by allowing any state that signs up for Medicaid expansion to receive a 100 percent federal match for the first three years. She would also continue to support a public option to broaden the choices of insurance for every American and lower out-of-pocket costs such as copays and deductibles. Interestingly, Clinton speaks of broadening the scope of health care providers eligible for telehealth reimbursement under Medicare and other programs, and supports states’ efforts to streamline licensing for telemedicine and examine ways to expand the types of services that qualify for telehealth reimbursement.

In the end, while it is important who inhabits the White House, it’s just as important who is in the House and Senate. Take a look at your House and Senate candidates, and examine their positions and their historical records. And most importantly, make sure you vote Tuesday, November 1.