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December 7, 2020

Reform, repeal, repeat: Health care policies of the presidential candidates

The health care policies of the leading presidential candidates reflect the party divisions of the past several years. Hillary Clinton favors continuing and improving the Patient Protection and Affordable Care Act (ACA). Donald Trump favors repealing the ACA and relying on the private sector to provide health insurance.

Clinton’s health plan

Clinton says she wants both to build on the ACA and to make it more affordable. She would do this by increasing tax credits for those who buy insurance on the exchanges. Under her plan, a family could receive a tax credit of up to $5,000 per year to help cover their out-of-pocket expenses.

Families with high-deductible plans, however, could still face a financial hit; as of this year, the government allows an out-of-pocket maximum of $6,850 for individual policies and $13,700 for family policies. (These figures are for in-network care. If a patient receives out-of-network care, out-of-pocket expenses could be higher.)

Like President Obama, Clinton supports expansion of Medicaid and plans to maintain Obama’s proposal that the federal government will pay any state that signs up for Medicaid expansion 100 percent of the expansion’s cost for the frst three years.

According to the u.s. Census Bureau, approximately 33 million Americans still lack health insurance (down from 41.8 million in 2013). Clinton notes that 16 million of the uninsured are eligible for Medicaid or insurance through the exchanges. According to her website, she would spend $500 million per year "in an aggressive enrollment campaign to ensure more people enroll" in these options.

To help people who live in rural areas, Clinton would expand services and increase reimbursement for telehealth under Medicare and other government programs.

Clinton also promises to defend Medicare against Republican attempts to privatize it. She would allow the Medicare program to negotiate with drug and biologic manufacturers for lower prices and higher rebates. In addition, she would allow Americans to purchase lower-cost drugs from foreign countries, provided the countries have appropriate safety standards. To promote quality of care and save costs, Clinton would expand ACA programs that base payments on episodes of care or "bundles," as well as provide incentive payments for coordinated care and high quality care.

Alzheimer’s disease drew special attention from Clinton. She promised to invest $2 billion per year in the National Institutes of Health (NIH) for Alzheimer’s and related disorders - more than three times what the NIH invested in Alzheimer’s research last year. With this funding, she says a cure should be possible by 2025. Her plan would also have Medicare cover comprehensive Alzheimer’s care planning sessions.

Trump’s health plan

Last year, Donald Trump’s health care policy was rather vague. In a July 2015 interview with CNN’s Dana Bash, he said that the ACA has "gotta go" and that he would replace it with "something terrifc." Since then, he has become more specifc.

On his website, Trump says that he "and a Republican congress will lead the effort to bring much-needed free market reforms to the healthcare industry." In addition to completely repealing the ACA, Trump gives top-billing to modifying existing laws that limit the sale of health insurance across state lines. "As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state."

Like Clinton, Trump favors revising tax laws to help people obtain health coverage. Trump would allow individuals "to fully deduct health insurance premium payments from their tax returns." In addition, he holds that contributions to health savings accounts "should be tax-free and should be allowed to accumulate." These accounts, he said, "would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty."

These tax benefts are more likely to help people with higher incomes. For low income individuals who may not pay taxes and may be unable to afford health insurance, the tax breaks would be of little assistance. For those with very low income, Trump favors the continuation of Medicaid. He would make block-grants to states and would impose few federal regulations on how the states use the money.

Like Clinton, Trump would allow consumers more access to drugs from other countries. "Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers," Trump said.

Immigrants and health care

The candidates’ attitudes about immigration also have a ripple effect on their health care policies. Trump says enforcing immigration laws and not providing health care to those who live in the U.S. illegally would save billions of dollars annually. Clinton says she would reduce the unreimbursed costs of health care for immigrants by allowing all families to purchase insurance on the ACA exchanges, regardless of their immigration status.

Clinton and Trump’s views about the role of government overall are reflected in this health care debate. Clinton believes the federal government should play a large role in ensuring people have insurance and in managing the health care system. Trump favors a smaller role for the federal government, thereby leaving more decisions to the state government, the private sector and the individual.



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