How Would Healthcare Look Under the Next President?

by Amanda Garcia

Election Day is coming fast and Americans are learning more and more about what the country may look like under each presidential candidate’s administration.

One area where the differences between presidential candidates Hillary Clinton and Donald Trump are most pronounced is on health care.

Gerald F. Kominski, Ph.D., director of the UCLA Center for Health Policy Research, recently held a seminar examining their plans. Here’s how Kominski feels the U.S. health care system could look during the next four years depending on who wins the presidency.

Clinton’s Health Care Proposal:

Maintain and build upon the ACA

Since her campaign began, Clinton has held fast to her position of maintaining and building upon the Affordable Care Act (ACA), also known as Obamacare, which was passed into law six years ago.

She wants to lower the maximum ACA premium to make it more affordable for those who qualify for tax credits to purchase health insurance in the exchanges. She also wants to allow undocumented residents in the U.S. to buy health insurance without the aid of subsidies.

Clinton would like to establish cost-sharing tax credits for everyone with private health insurance to offset out-of-pocket spending above 5% of an individual’s or family’s income. These tax credits would be up to $2,500 for individuals or $5,000 for families.

Additionally, Clinton is looking to eliminate the “family glitch” in Obamacare, which basically says that if the family breadwinner has “affordable” coverage through an employer, the family doesn’t need a subsidy. Clinton’s plan would allow families that pay more than 8.5% of their income for employer-sponsored insurance to apply for subsidies.

Clinton has been a big advocate of ACA price transparency requirements and wants to eliminate “surprise bills” for out-of-network services when an insured individual obtains care at an in-network hospital.

Overall, Kominski estimates that Clinton’s proposal to build on Obamacare would reduce the number of uninsured Americans by roughly 10 million people.

Expand and improve Medicare and Medicaid

Clinton would allow 55- to 64-year-old Americans to buy-in to Medicare. She would also allow Medicare to negotiate prescription drug prices, and make Medicaid (MediCal in California) rebates available to low-income Medicare beneficiaries.

Clinton also wants to extend a 100% federal subsidy for Medicaid expansion to the 19 states that did not expand their Medicaid programs to take part in the Affordable Care Act.

Tackle high drug costs

Clinton wants to establish a $250 monthly limit on out-of-pocket prescription drug costs. She also advocates allowing patients to import drugs that meet U.S. safety standards.

Clinton supports the faster development of generic drugs by eliminating “pay to delay” deals with pharmaceutical companies, as well as fully funding the Federal Drug Administration (FDA) Office of Generic Drugs.

Additionally, Clinton wants to eliminate tax deductions for direct-to-consumer advertising by pharmaceutical companies and require FDA approval of these ads.

Protect reproductive health initiatives

Clinton would look to repeal the Hyde Amendment, a legislative provision that prevents the use of certain federal funds to pay for abortion (except to save the life of the mother, or if the pregnancy comes from incest or rape). This would primarily affect those insured through Medicaid/MediCal.

She also openly opposes efforts to defund Planned Parenthood and wants to preserve access to affordable contraception, as well as safe, legal abortions.

Trump’s Health Care Proposal

Repeal and replace Obamacare

Trump has promised to repeal and replace Obamacare if he becomes the next U.S. president. However, he hasn’t provided a specific plan for replacing the Affordable Care Act yet.

If this does come to pass, Kominski predicts that about 20 million people will return to the ranks of the uninsured. And, if you have pre-existing conditions, you may be on your own again when it comes to getting health care.

Allow the sale of health insurance across state lines

Trump wants to modify the existing law that prohibits the sale of health insurance across state borders. This would allow health insurance companies to incorporate in a state that offered the fewest regulatory requirements. Then these companies could market their health insurance policies nationally without being subject to insurance regulations of other states.

This policy ultimately benefits high-income individuals in good health because it allows health insurance companies to deny coverage to high-risk individuals.

Deduct health insurance premiums from tax returns

Trump would allow individuals to fully deduct their health insurance premium payments from their tax return under the current tax system. Therefore, the higher your tax bracket, the more beneficial this policy would be for you.

Since the self-employed can already do this, it would primarily affect those who are not self-employed and who have to buy insurance because they don’t have it through their employer.

Promote block grants for Medicaid to the states

Block grants would allow states to set their own Medicaid eligibility thresholds for people who don’t fall into one of the standard categories. This would apply mostly to adults without children.

Essentially, this policy would limit the federal government’s liability regarding Medicaid (Medi-Cal) funding, and give more authority over funds back to the states.

Remove free market barriers for drug providers

Trump would like to legalize the re-importation of prescription drugs that are manufactured in the U.S. but are only available for sale in other countries. He would have to work with the FDA on this, because it certifies the safe manufacturing standards of drugs available around the globe.

Restrict health care to undocumented immigrants

Trump’s campaign website states that, “Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigrations laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.”

According to Kominski, that $11 billion is less than 0.5% of total national health spending in 2016, so Trump’s policy of keeping undocumented immigrants from receiving health care may not have a profound fiscal effect overall.

Amanda Garcia is Associate Producer of SoCal Connected, KCET's weekly award-winning, prime time newsmagazine. 

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