Comparing Trump and Clinton Health Reform Proposals

During the 2016 Presidential Campaign, both the Democratic Party Candidate, Hillary Clinton, and the Republican Party Candidate, Donald Trump have offered policy proposals aimed at addressing health care in the United States. Both sets of proposals are framed within the context of the current provisions of the 2010 Affordable Care Act (ACA), which has shaped the American health insurance market and health care industry over the past six years. Mr. Trump’s proposals seek to fully repeal the ACA and “follow free market principles” to health care costs and secure access to health care (Trump, 2016). Secretary Clinton’s proposals will implement reforms to the existing ACA provisions to ensure access and reduce costs (Clinton, 2016). Secretary Clinton’s plans also address innovation in medicine and value-based care. The plans differ fundamentally in their view of the federal government’s role in the health insurance market and health care industry.

Mr. Trump’s health policy proposals focus on repealing the ACA and protecting free market principles to promote economic growth and reduce health care spending (Trump, 2016). Dismantling the ACA would reverse key provisions that aimed at expanding coverage to the uninsured. Projections suggest that two aspects of Mr. Trump’s plan, repealing the ACA and implementing a tax deduction for people in the individual market “would result in 15.6 fewer people with health insurance” (Saltzman, Eibner, 2016). Implementing Medicaid block grants to the states rather than maintaining Medicaid’s entitlement program status would further reduce the number of insured by about 25 million (Saltzman, Eibner, 2016). Modeling also suggests that annual out-of-pocket expenditures under several key components of Mr. Trump’s (repeal the ACA, implement a tax deduction, and allow for sale across state lines) would increase by about $2500. Finally, Mr. Trump’s plan is projected to “increase the federal deficit by $0.5 billion to $41 billion” (Saltzman, Eibner, 2016). Overall, projections under Mr. Trump’s plan suggest increased out-of-pocket spending, increased federal deficit, and reduced number of insured.

Secretary Clinton’s health care proposals focus on four main goals: maintain the ACA, ensure affordability, secure high-quality health care, and promote innovation (Clinton, 2016). Within these goals, Secretary Clinton aims to implement “enhanced tax credits,” expand Medicaid in states that have not yet expanded, and implement a “public option” for those seeking health coverage outside of the group market (Clinton, 2016). These proposals will also address the increased premium costs under the ACA (Pear, 2016) Secretary Clinton will also implement a tax credit for excessive health care expenditures and aims to control prescription drug costs by addressing the patent waiting period for generic drugs (Clinton, 2016). Projections of Secretary Clinton’s plan suggest that including a tax credit as well as a public option will increase the number of insured individuals by 10 million (Eibner, Nowak, Liu, 2016). The tax credit is estimated to increase the federal deficit by $90.3 billion. The the public option is projected to reduce the federal deficit by $0.6 billion. Additionally, Secretary Clinton’s major proposed provisions are projected to reduce out-of-pocket expenditures, however not all proposed policies reduce out-of-pocket expenditures across all populations (Eibner, Nowak, Liu, 2016).

Secretary Clinton’s seeks to expand the federal government’s role in the health insurance by recommending a federally administered public option, robust tax credits, and efforts to expand Medicaid. While Secretary Clinton’s policy proposals are projected to further reduce the number of uninsured as compared to current rates of insured under the ACA, these proposals are also projected to increase the federal deficit. Political turmoil surrounding the public option as well as Medicaid expansion and increased federal spending may be roadblocks to implementation. In contrast, Mr. Trump’s plans seek to reduce federal government involvement in health insurance markets and health care. However, projections of Mr. Trump’s plans suggest a negative impact on the number of uninsured, out-of-pocket expenses, and federal spending compared to the current ACA provisions. Given the lack of redeeming qualities of Mr. Trump’s plan compared to Secretary Clinton’s plan, Secretary Clinton’s plan will likely provide the greatest benefit to the country of the two plans.

Clinton H. My Vision for Universal, Quality, Affordable Health Care. New England Journal of Medicine. 2016;375(17):e36.

Eibner, C., Nowak, S., and Liu, J. Hillary Clinton’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit, The Commonwealth Fund, September 2016.

Pear R. Some health plan costs to increase by an average of 25 percent, U.S. Says. New York Times. October 25, 2016. http://www.nytimes.com/2016/10/25/us/some-health-plan-costs-to-increase-by-an- average-of-25-percent-us-says.html?_r=0.

Saltzman, E. and Eibner, C. Donald Trump’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit, The Commonwealth Fund, September 2016.

Trump, D. Healthcare Reform. Donald J. Trump. 2016.