The future of health care, according to Clinton or Trump

Many Americans’ health care — and the roiling health-care debate in Washington — is likely to be very different depending on whether Democrat Hillary Clinton or Republican Donald Trump becomes the next president. We looked at what both have said they would do with major aspects of the health-care system. And to put their views in perspective, in part through analyses of experts across the ideological spectrum, we are annotating each candidate’s positions using Genius.
The statements you see below in italics are from the two campaigns’ position papers; the rest is our paraphrase. To see an annotation, click or tap the highlighted part of the text.

Overview

Clinton strongly favors the Affordable Care Act. She wants to build on it in several ways, however, extending tax credits, making more people eligible for exchanges and Medicare, and tackling prescription drug prices.

Though Trump has broken with conservatives of his own party on many issues, his health-policy positions are largely in line with GOP orthodoxy. He wants to end the Affordable Care Act. He also wants to transform Medicaid into state block grants, create high-risk insurance pools for people who need a lot of medical care and permit insurance to be sold across state lines.

At think tanks and elsewhere, health policy experts have assessed the overall impact of the Clinton and Trump plans on the number of Americans with insurance and on federal spending. While the numbers vary, all conclude that her proposal would increase coverage and his would diminish it. Analyses disagree, though, on the impact of their plans on the federal deficit.

Affordable Care Act

The sprawling 2010 law — President Obama's signature domestic achievement — has brought the biggest expansion of coverage of any U.S. health policy change in decades. It also has fueled the most intense partisan feuding.

Clinton
Defend and expand the Affordable Care Act.

Trump
On day one . . . ask Congress to immediately deliver a full repeal of Obamacare.

Health Insurance Coverage and Costs

Overall, U.S. health spending has grown relatively slowly in the past decade, but costs have shifted onto consumers, and prescription drug prices have spiked. As the ACA’s fourth enrollment period gets underway this month, rates for a significant group of midlevel health plans in the federal exchange, HealthCare.gov, are soaring by an average of 25 percent.

Clinton
Let states choose to have a “public option” of government-administered insurance that would compete with private health plans in the ACA marketplaces.

Increase premium tax credits available through the [ACA] marketplaces so that individuals and families pay no more than 8.5 percent of their income on health insurance premiums.

Bring down out-of-pocket costs like copays and deductibles. Create a new refundable tax credit of $2,500 per person or $5,000 per family if they have “excessive” costs, probably more than 5 percent of their income.

Repeal the “Cadillac tax” on high-cost health insurance.

Fix the law’s so-called “family glitch,” which prevents family members of some employees with private health benefits for themselves from qualifying for subsidies in ACA marketplaces.

[A]llow … families to buy health insurance on the health exchanges regardless of their immigration status.

Trump
Require no one to buy insurance.

Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system.

Allow insurance companies to sell health plans across state lines.

Work with states to establish high-risk pools to ensure access to coverage for individuals who have not maintained continuous coverage.

[R]eplace Obamacare with health savings accounts (HSAs).

Medicare

This entitlement program, created in the mid-1960s as part of President Lyndon Johnson's Great Society, provides insurance to about 55 million Americans who are 65 and older or have disabilities.

Clinton
Allow people 55 and older to buy into Medicare.

Give the federal government authority to use its leverage to negotiate drug prices for Medicare beneficiaries.

Trump
The proposals on his campaign website do not mention Medicare. But he said in January that Medicare could “save $300 billion” annually by negotiating drug prices with major pharmaceutical companies.

Medicaid

Another 1960s-era entitlement program, Medicaid insures low-income people and is a shared responsibility of the federal government and states. Along with the Children’s Health Insurance Program, it covers about 72 million people. The ACA intended a nationwide expansion to people with slightly higher incomes — 138 percent of the federal poverty level — but a 2012 Supreme Court ruling gave each state the option of expanding. Thirty-one states have.

Clinton
Urge the 19 states that have not expanded Medicaid under the ACA to do so. Would change the law so that the government pays the full cost of expansion for the first three years, no matter when a state begins

Trump
Change Medicaid to a block grant to states.

Prescription Drugs

The skyrocketing prices of some prescription drugs during the past couple of years has made pharmaceuticals a hot political topic and put drugmakers on the defensive.

Clinton
Allow Americans to import drugs from abroad — with careful protections for safety and quality.

Stop direct-to-consumer drug company advertising subsidies, and reinvest funds in research.

[R]equire health insurance plans to place a monthly limit of $250 on covered out-of-pocket prescription drug costs for individuals to provide financial relief for patients with chronic or serious health conditions.

Trump
[Allow] consumers access to imported, safe and dependable drugs from overseas.