A Look at the Candidates’ Health Care Proposals

When you enter the voting booth in November, there are lot of things to consider and a lot of reasons to vote for—or against—one of the two major candidates running for President. This article has nothing to do with that. Everyone has their own political issues that are important to them, and it’s not our job to tell you how to vote. That said, we know that agents are concerned about how this election might affect the Affordable Care Act in 2017 and beyond, and we also know that your clients will be looking to you for guidance. With that in mind, we believe this is a great time for a quick overview of both Hillary Clinton’s and Donald Trump’s health care proposals. You can get more information on the Clinton and Trump campaign websites.

Hillary Clinton

Obviously, Hillary Clinton has a long history of fighting for health care reform. While many were under the impression that it started when she was First Lady, she was actually involved in health care at a state level in Arkansas more than a decade earlier, and she continued her fight as Senator of New York and during her unsuccessful presidential campaign eight years ago.

Given her background, it’s easy to see why health reform would be a major issue for Secretary Clinton, and we can see from her website that she has a very detailed proposal. Here are the high points of the Clinton health care plan:

• While her opponent would like to repeal and replace the health reform law, Clinton vows to “defend and expand” the ACA.
• In an effort to reduce premiums and expand choice, she will introduce a “public option” that will compete with insurance companies and create additional health insurance options for consumers.
• She will also expand Medicare, allowing people age 55 and older to buy into the government program.
• Clinton will cap out-of-pocket costs like copayments and deductibles and address rising prescription drug costs by denying tax deductions for direct-to-consumer advertising, requiring investment in research & development, speeding up the introduction of generic alternatives, and creating a federal backstop for high-priced drugs that have no direct competitors.
• She will reduce the number of uninsured by incentivizing states to expand Medicaid and by allowing families to purchase health insurance regardless of immigration status.
• Finally, she will increase access to healthcare by expanding telemedicine and increasing funding for community health centers.

Donald Trump

Donald Trump, while new to politics, has repeatedly voiced his opinion about health reform over the last few years. In 2000, Trump actually supported a single-payer system like Bernie Sanders called for during his campaign, but more recently Mr. Trump has spoken out against single payer and claimed that “Obamacare” is “a big, fat, horrible lie” [source: BuzzFeed] and a scheme by liberals “to drag America closer to…total government-run health care” [source: Politico].

On Donald Trump’s website, we can see that he’s offering “Healthcare Reform to Make America Great Again.” In addition to asking Congress “to immediately deliver a full repeal of Obamacare” on “day one of the Trump Administration,” here are the major points of the Trump health care plan:

• Mr. Trump will eliminate the individual mandate. This is a separate line item on his proposal, but the individual mandate would go away if his efforts to repeal the ACA are successful.
• Instead of the current Advance Premium Tax Credits that are part of the health reform law, Trump supports an individual health insurance deduction. People will be able to fully deduct their health insurance premiums when they file their taxes.
• He will also modify existing laws that inhibit the sale of health insurance across state lines.
• Mr. Trump will expand the use of Health Savings Accounts by making them more flexible. To increase consumerism, he will require price transparency from all healthcare providers.
• To reduce prescription drug costs, Trump will remove barriers to entry for drug providers that offer safe, reliable, and less expensive products.
• Instead of expanding Medicaid, he will block grant the program to states so that those who want healthcare coverage can have it.

Checks and Balances

Of course, we live in the United States, and the president cannot simply dictate what changes will be made to the health care system. Any major changes require congressional action, and even then the Supreme Court is often asked to decide if those changes are constitutional. This is important because, along with a presidential election, voters this fall will decide if Republicans retain control of the House and/or the Senate. Ultimately, that election could have an even bigger impact on what happens to the Affordable Care Act.

Assuming Donald Trump is elected President and Republicans retain control of both chambers, “repeal and replace” is actually possible, but the replacement plan may not be what Trump has in mind. Speaker Ryan has his own health care proposal called “A Better Way.” While not in bill format yet, the House Republicans’ proposal is meant as a conversation starter and contains a number of talking points that would likely find their way into a replacement plan, including the following:

• The Republican proposal would preserve government programs like Medicare and Medicaid and, like Trump’s plan, would provide Medicaid block grants to the states. Additionally, the plan would provide premium assistance to some Medicare beneficiaries.
• Also like Trump’s plan, the Ryan plan would expand the use of Health Savings Accounts and allow for the purchase of coverage across state lines.
• Because the Republican proposal would repeal the Affordable Care Act and the guaranteed issue provision along with it, people with pre-existing medical conditions could purchase coverage through high risk pools. Plans would also be guaranteed issue for people who have had continuous coverage.
• The plan would replace the ACA’s current 3-to-1 age bands in the individual and small- group markets with 5-to-1 age bands.
• Under the proposal, there would be individual market tax credits that are adjusted for age rather the current income-based premium tax credits.
• Lastly, the Ryan plan would cap the employer exclusion, which, similar to the Cadillac tax, could have negative effects on tax-advantaged accounts like FSAs and HSAs and on ancillary benefits that are paid with pre-tax dollars.

Should Democrats win the White House and gain control of both chambers, though, Hillary Clinton would have a shot at getting her proposed changes implemented. And if there’s some sort of split—a Democratic president and Senate and a Republican House, for instance—it will be very difficult for either side to make significant changes to the existing law. Without some sort of compromise, which has been very rare for the last eight years, we can expect the Affordable Care Act to continue as is with occasional congressional action on minor changes and some regulatory adjustments along the way.

Finally, we can’t underestimate the importance of the presidential election as it relates to the Supreme Court. There is currently one vacancy that will be filled by the next President, and many expect the next President to nominate one to three additional justices over his or her term(s) in office. With a lawsuit over the cost-sharing subsidies likely on its way to the Supreme Court and other challenges to follow, the makeup of the Court is critically important to the future of the health reform law.

What you should tell your clients

Ultimately, how you communicate with your clients about divisive issues like a presidential election is up to you, but we’d like to give you two pieces of advice.

First, share the facts while remaining as politically neutral as possible. People are very passionate about politics, especially this year, and if you get too political you run the risk of offending or alienating some of your clients. It’s better to tell them how the election could impact their health plan options in the event of a Clinton or Trump victory than to share your personal viewpoints about the candidates.

Second, people are concerned about the future of the Affordable Care Act and are looking for guidance, so if you’re able to explain the potential changes in a simple and reassuring manner, this can actually help you pick up additional business. In other words, you can use this crazy political climate as a prospecting tool if you can explain things better to your prospective clients than their current agent can.

November 8th will be here before you know it, and while we’ll still be guessing about what will happen, we’ll be able to make more educated guesses than we can right now. As we learn more about the proposed changes and their likelihood of becoming law, we’ll continue to share what we know with you.

The content of this article does not represent an official endorsement by AHCP of any candidates mentioned herein, or any plans or proposals set forth by such candidates.