The outcome of the 2016 presidential election will determine how much people have to pay for health insurance, and whether they will have coverage in the coming years. Democrat Hillary Clinton and Republican Donald Trump have both released plans addressing the Affordable Care Act, rising premiums, and states that have not expanded Medicaid.
Nonprofit research group RAND Corporation took a deep dive into both candidates’ health care plans. Here’s their analysis.
Clinton, if elected, would continue the Affordable Care Act. She’d add a government-run public insurance plan to compete with private plans in marketplaces, which many insurers are pulling out of. She’d also open up individual market insurance to immigrants, regardless of their immigration status.
Christine Eibner is senior economist with RAND. Eibner said the biggest change Clinton would bring to the ACA is a cap on how much people spend on health care.
“The cost sharing tax credit would cap spending at five percent of income, and spending over that would be subsidized through a tax credit,” Eibner said.
The tax credit would reimburse single people for $2,500 in health care expenses, and $5,000 for families. This would apply to everyone, including people with insurance through their employer. Because coverage would be more affordable, 9.6 million people would gain health insurance, according to RAND’s analysis. But RAND also estimates the program would add $90 billion to the federal debt.
Clinton is also proposing that people 55 and up could enroll in Medicare – right now the requirement is 65 and older. Sara Collins, vice president of health care coverage at The Commonwealth Fund, said Clinton’s proposals are mainly aimed at improving the ACA and fixing problems. Another goal would be to get more states to expand Medicaid.
“She’s proposing that states that haven’t expanded Medicaid yet could get 100 percent matching funds if they move forward over the next three years, similar to what states that already expanded coverage received,” Collins said.
RAND’s analysis of Trump’s plan shows it would cost the government $33 billion. Trump has said he would do away with subsidies and most of the ACA. That would also mean an end to Medicare reforms that were included in the ACA to pay for the subsidies. Trump’s plan would also eliminate the tax on people who don’t buy insurance, and a tax on medical device makers.
Trump’s plan would allow consumers to buy plans across state lines, which would allow for greater competition. His plan would also allow people to get a tax deduction for buying insurance on the individual market.
Average out-of-pocket costs for people buying insurance on the individual market would increase to $4,700 under Trump’s plan because the repeal would take away consumer protections like barring insurers from selling or hiking up prices for people with existing health conditions. Twenty million people would lose coverage, according to RAND’s analysis.
Eibner from RAND said because of the rollback of these consumer regulations, insurers would flock to states where protections are looser.
“Premiums would fall in those states and would rise in other states,” said Eibner. “We’d have a situation where older and sicker people would find it more difficult to purchase a policy, and younger and healthier people would find it easier to find a policy, but it’d be more bare-bones than under the ACA.”