The 2016 presidential election will play a crucial role in determining the future of American health care. Under the Affordable Care Act, millions of people have gained access to affordable health insurance. But a new president could change certain features of the law or eradicate it altogether. Presumptive nominees Hillary Clinton (Democrat) and Donald Trump (Republican) have opposing viewpoints when it comes to getting health insurance. It’s likely that one of these candidates will become the next president, which means that their stances on the health care system matter. In this article, we’ll compare the health care plans proposed by each candidate so that you’ll have a better idea of each party’s position.
Basic Beliefs about Health Care
In general, Republicans and Democrats have differing – and often opposing – viewpoints on health care and the way it should work in America. Hillary Clinton believes in universal health care, meaning that everyone should be able to get health insurance regardless of ability to pay. According to her campaign website, she believes that affordable health care “is a basic human right.” As such, her health care plan centers on ensuring that people continue to gain access to cost-effective coverage.
Donald Trump also believes that health care should be available for everyone, but his plan depends less on government control and more on individual choice. He has suggested that free market reforms will encourage people to participate even without the individual mandate that compels eligible citizens to get health insurance. Several of his reforms seem contradictory to the idea of universal coverage. However, his underlying philosophy is that choice plays the biggest role in obtaining health care.
Incremental Changes vs. Repeal and Replace
According to her campaign site, “Hillary will continue to defend the Affordable Care Act (ACA) against Republican efforts to repeal it.” She believes that the current health care system under the ACA is a step in the right direction toward making sure that people have access to good insurance. Hillary intends to keep the existing laws in place while making incremental changes over time to improve on Obamacare. Her plan includes:
- Making premiums more affordable
- Lowering out-of-pocket costs for those who buy health insurance on the marketplaces
- Investing a substantial sum into better advertising and marketing initiatives to make enrollment clearer and easier on those who don’t understand the system
- Expanding health insurance options to illegal immigrants
- Encouraging more states to expand their Medicaid programs
- Offering a public option as was intended in the original proposal of the ACA
She also intends to tackle the issue of rising drug costs, one of the major problems in today’s health care system. Hillary wants to keep the ACA intact because she believes that it’s working. Her proposed health plan simply expands on key elements of Obamacare.
By contrast, Trump contends on his campaign website that on “day one” of his administration, “we will ask Congress to immediately deliver a full repeal of Obamacare.” He believes that Americans have seen higher costs, fewer benefits and a restriction on personal freedoms as a result of the ACA. As such, he wants to repeal the law completely and replace it with his own plan. Trump’s health care plan involves seven basic features:
- Repealing the Affordable Care Act
- Allowing insurers to sell across state lines
- Letting people deduct health insurance premiums from their tax returns
- Allowing individuals to use Health Savings Accounts and expanding their scope
- Requiring price transparency from health care providers
- Reforming Medicaid funding into a block-grant system
- Allowing international drug manufacturers to import drugs into the states
Trump also plans to reform immigration, an issue that he believes plays a large role in driving up the cost of health care in the United States. His plan does not offer many specifics, and not every Republican agrees. In fact, Republicans in Congress released their own health care reform plan in June, so it remains to be seen if Trump can work through the details with his own party. Trump’s plan essentially calls for less government oversight on health care and more individual choice.
The Cost of Health Insurance
Both Hillary and Trump have proposed changes to the current health care system, but some changes are more drastic than others. This means that each candidate’s plan has a different economic impact. How much you’ll pay for insurance depends on who becomes president and how the law changes, so it’s important to note how the U.S.’s health care finances could be affected by this election. Becker’s Hospital Review compiled a list of six key financial facts to consider between Hillarycare and Trumpcare. The table below highlights some of the projected costs over the next 10 years.
Hillarycare and Trumpcare share a common goal of reducing the national debt as well as national spending on health care, but the candidates’ approaches differ wildly in some areas. For instance, Hillary wants to eliminate the deduction for advertising costs that pharmaceutical companies currently take. This would result in a savings of about $50 billion by 2026. Trump wants to change how Medicaid gets funded by using a block-grant system, which could result in a reduction of the national debt by as much as $1.05 trillion – or nothing at all. The Committee for a Responsible Federal Budget estimates that the savings would be about $500 billion over the next decade.
It’s also difficult to determine how each candidate’s plan would impact the long-term federal budget since the proposed changes don’t offer many details. For example, Hillary has proposed offering “incentives” for states to expand Medicaid, including continuing the ACA’s 100 percent fund-matching for the first three years, but she has not gone into detail about what these incentives might entail. Likewise, Trump suggests that allowing the free market to dictate health insurance would generate savings, but he has yet to offer any concrete figures on what these savings would mean for the average consumer.
Based on the figures compiled by Becker’s Hospital Review, it would appear that Hillary’s plan generates better savings over the next ten years. However, these fiscal comparisons may need to be adjusted as the candidates offer more details on how their plans might be accomplished.
Special Features and Proposed Changes
Both candidates want to tackle specific areas of health care. Hillary is committed to keeping the current law in place, but she has proposed key changes in an effort to expand on the ACA’s main ideas. Among these changes are:
- Expanded access to rural Americans: Hillary wants to help people in rural areas gain access to health care through special services, such as telemedicine and reimbursement under Medicare for these services.
- Lower-cost prescription medication: No specifics are given on her campaign website, but Hillary has proposed reducing the burden of excessive prescription costs “for hardworking families and seniors.”
- A cap in out-of-pocket spending: Under Hillarycare, families could be granted a tax credit of up to $5,000 to offset the cost of out-of-pocket expenses when those expenses exceed 5 percent of a family’s income.
- Incentives for “value and quality”: Hillary does not elaborate on this point, but her site claims that she wants to reward providers for improving value and quality in terms of health care delivery.
The seven features of Trumpcare have been outlined above, but Trump also wants to reform two areas of the health care system that fall outside of his basic principles: mental health and social programs. He wants to reform mental health care by ensuring that families who need mental health support gain appropriate information and resources to take care of ailing loved ones. He claims that “promising reforms” are being developed in Congress “that should receive bi-partisan support.”
In addition, Trump wants to mitigate the reliance on social welfare programs. According to his campaign site, “The best social program has always been a job.” He believes that stimulating the economy is the most effective way to reduce the number of people who need Medicaid and the Children’s Health Insurance Program. Trump has not elaborated on this point, but based on his other objectives, it’s clear that he believes that the free market will spark economic growth if left unregulated.
Focus Areas: Women’s Rights vs. Immigration
The candidates are divided on a number of key health care issues, but each has targeted one area of U.S. policy in their stated health care proposals. For Hillary Clinton, the issue is women’s rights. According to her campaign site, Hillary has been a champion of women’s health care rights since her political career began. This includes support for things like emergency contraceptives, Planned Parenthood and abortion. She also intends to end restrictions on women’s reproductive rights, such as the Hyde Amendment, which limits federal funding of abortion to specific instances.
Donald Trump focuses his energy on immigration. His campaign site asserts that providing health care services to illegal immigrants costs about $11 billion a year. If the U.S. tightens and enforces current immigration laws, he argues, then costs would go down. He wants to “restrict the unbridled granting of visas” in an effort to “relieve healthcare cost pressures on state and local governments.”
This November, Americans will head to the polls around the same time that open enrollment begins for the 2017 season. Aside from the practical matters of health care costs and delivery, there are other major issues to consider when thinking about the future of health insurance access and affordability. Large insurers are starting to pull out of the marketplaces, premium rates are once again expected to skyrocket and young people aren’t enrolling as anticipated. Addressing these issues will play an important role in the stability of the current system as well as its future. Whether Hillary Clinton or Donald Trump has the answer remains to be seen, but it’s important to consider each candidate’s positions and guiding philosophy regarding health care in America.